Advertisement

Combination therapy with cytapheresis plus vedolizumab in a corticosteroid-dependent patient with ulcerative colitis and previous ANTI-TNF-α drug failure

  • Esteban Sáez-González
    Affiliations
    Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain

    Inflammatory Bowel Disease Research Group, IIS Hospital La Fe, Valencia, Spain
    Search for articles by this author
  • Mariam Aguas
    Affiliations
    Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain

    Inflammatory Bowel Disease Research Group, IIS Hospital La Fe, Valencia, Spain

    Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
    Search for articles by this author
  • José M. Huguet
    Affiliations
    Inflammatory Bowel Disease Unit, Department of Digestive Diseases, University General Hospital of Valencia, Spain
    Search for articles by this author
  • Pilar Nos
    Correspondence
    Corresponding author at: Inflammatory Bowel Disease Unit and Inflammatory Bowel Disease Research Group, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
    Affiliations
    Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain

    Inflammatory Bowel Disease Research Group, IIS Hospital La Fe, Valencia, Spain

    Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
    Search for articles by this author
  • Belén Beltrán
    Affiliations
    Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain

    Inflammatory Bowel Disease Research Group, IIS Hospital La Fe, Valencia, Spain

    Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
    Search for articles by this author
Published:February 02, 2018DOI:https://doi.org/10.1016/j.dld.2018.01.124
      Ulcerative colitis (UC) is a chronic, relapsing gastrointestinal disorder characterised by inflammation of the colonic mucosa [
      • Magro F.
      • Gionchetti P.
      • Eliakim R.
      • Ardizzone S.
      • Armuzzi A.
      • Barreiro-de Acosta M.
      • et al.
      Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders.
      ]. The therapeutic goal of UC treatments is to induce steroid-free clinical remission, which is defined as the complete resolution of symptoms, with stool frequency ≤3/d without bleeding or urgency and endoscopy without mucosal lesions [
      • Harbord M.
      • Eliakim R.
      • Bettenworth D.
      • Karmiris K.
      • Katsanos K.
      • Kopylov U.
      • et al.
      Third European evidenced-based consensus on diagnosis and management of ulcerative colitis: part 2: current management.
      ]. Common therapeutic agents used to control disease activity include 5-aminosalicylate compounds, steroids, immunosuppressants (thiopurines), calcineurin inhibitors (cyclosporine, tacrolimus), and biologic drugs such as anti-tumour necrosis factor (TNF)-α (infliximab/adalimumab) and the anti-adhesion molecule vedolizumab. Biologic therapies with anti-TNF-α drugs have demonstrated their efficacy in the induction and maintenance of remission for the treatment of UC. However, there is a subgroup of patients who do not respond adequately to these treatments. In this clinical setting, alternative treatments or colectomy should be considered [
      • Magro F.
      • Gionchetti P.
      • Eliakim R.
      • Ardizzone S.
      • Armuzzi A.
      • Barreiro-de Acosta M.
      • et al.
      Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders.
      ,
      • Harbord M.
      • Eliakim R.
      • Bettenworth D.
      • Karmiris K.
      • Katsanos K.
      • Kopylov U.
      • et al.
      Third European evidenced-based consensus on diagnosis and management of ulcerative colitis: part 2: current management.
      ].
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Magro F.
        • Gionchetti P.
        • Eliakim R.
        • Ardizzone S.
        • Armuzzi A.
        • Barreiro-de Acosta M.
        • et al.
        Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders.
        J Crohns Colitis. 2017; 11: 649-670
        • Harbord M.
        • Eliakim R.
        • Bettenworth D.
        • Karmiris K.
        • Katsanos K.
        • Kopylov U.
        • et al.
        Third European evidenced-based consensus on diagnosis and management of ulcerative colitis: part 2: current management.
        J Crohns Colitis. 2017; 11: 769-784
        • Sáez-González E.
        • Moret I.
        • Alvarez-Sotomayor D.
        • Díaz-Jaime F.C.
        • Cerrillo E.
        • Iborra M.
        • et al.
        Immunological mechanisms of adsorptive cytapheresis in inflammatory bowel disease.
        Dig Dis Sci. 2017; 62: 1417-1425
        • Thanaraj S.
        • Hamlin P.J.
        • Ford A.C.
        Systematic review: granulocyte/monocyte adsorptive apheresis for ulcerative colitis.
        Aliment Pharmacol Ther. 2010; 32: 1297-1306
        • Sacco R.
        • Tanaka T.
        • Yamamoto T.
        • Bresci G.
        • Saniabadi A.R.
        Adacolumn leucocytapheresis for ulcerative colitis: clinical and endoscopic features of responders and unresponders.
        Expert Rev Gastroenterol Hepatol. 2014; 27: 1-7
        • Dignass A.
        • Akbar A.
        • Hart A.
        • Subramanian S.
        • Bommelaer G.
        • Baumgart D.C.
        • et al.
        Safety and efficacy of granulocyte/monocyte apheresis in steroid-dependent active ulcerative colitis with insufficient response or intolerance to immunosuppressants and/or biologics [the ART trial]: 12-week interim results.
        J Crohns Colitis. 2016; 10: 812-820
        • Ozeki K.
        • Tanida S.
        • Mizoshita T.
        • Tsukamoto H.
        • Ebi M.
        • Mori Y.
        • et al.
        Combination therapy with intensive granulocyte and monocyte adsorptive apheresis plus adalimumab: therapeutic outcomes in 5 cases with refractory Crohn’s disease.
        Case Rep Gastroenterol. 2012; 6: 765-771
        • Tanida S.
        • Mizoshita T.
        • Nishie H.
        • Ozeki K.
        • Katano T.
        • Kubota H.
        • et al.
        Combination therapy with adalimumab plus intensive granulocyte and monocyte adsorptive apheresis in patients with refractory ulcerative colitis.
        J Clin Med Res. 2015; 7: 884-889
        • Rodríguez-Lago I.
        • Gómez-Irwin L.
        • Fernández E.
        • Higuera R.
        • Cabriada J.L.
        Granulocyte-monocyte apheresis as an adjuvant therapy to anti-tumor necrosis factor drugs for ulcerative colitis.
        Ther Apher Dial. 2017; 21: 26-30
        • Beltrán B.
        • Sáez-González E.
        • Moret I.
        • Díaz-Jaime F.C.
        • Álvarez-Sotomayor D.
        • Cerrillo E.
        • et al.
        Adsorptive granulocyte/monocyte apheresis use in severe ulcerative colitis and determination of changes in plasma cytokines.
        J Clin Apher. 2017; : 9
        • Wang M.C.
        • Zhang L.Y.
        • Han W.
        • Shao Y.
        • Chen M.
        • Ni R.
        • et al.
        PRISMA—efficacy and safety of vedolizumab for inflammatory bowel diseases: a systematic review and meta-analysis of randomized controlled trials.
        Medicine. 2014; 93e326