A multicenter retrospective study aiming to identify patients who respond well to adsorptive granulomonocytapheresis in moderately to severely active ulcerative colitis.
A multicenter retrospective study aiming to identify patients who respond well to adsorptive granulomonocytapheresis in moderately to severely active ulcerative colitis.
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DOI：
10.1038/s41424-018-0037-0
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发表时间：
2018-07-06
影响因子：
3.6
通讯作者：
Hanai H
中科院分区：
文献类型：
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作者：
Yamamoto T;Iida T;Ikeya K;Kato M;Matsuura A;Tamura S;Takano R;Tani S;Osawa S;Sugimoto K;Shimoyama T;Hanai H
Adacolumn吸附性颗粒单核细胞分离术（GMA）已被引入作为溃疡性结肠炎（UC）的非药物治疗。然而，需要针对可能对GMA反应良好的患者子集。本研究在三个IBD中心进行，以确定影响GMA在中重度活动性UC患者中疗效的因素。从2008年1月至2017年12月，593例患者中共有894例活动性发作（首次发作或复发）接受了GMA治疗。临床缓解定义为排便频率正常且无直肠出血。在疗效评估中考虑了入组时的多个临床和实验室参数。在894例治疗病例中，422例（47%）达到临床缓解。在多变量分析中，对GMA有利反应的预测因素为年龄≤60岁、UC病程<1年、马约内镜分项评分2（vs. 3）、类固醇初治UC和生物制剂初治UC。临床缓解率在5个因素中的4个因素的患者中为70%，在3个因素的患者中为52%，在2个因素的患者中为46%，在1个因素的患者中为39%，在这些因素中没有的患者中为18%。总体而言，临床缓解率显着较高的患者有更多的五个预测因素（P < 0.0001）。GMA似乎对激素初治和生物制剂初治的UC病程较短的患者有效。老年患者（>60岁）和内窥镜活动严重的患者对GMA反应不佳。另外，精心设计的前瞻性对照试验应该会加强我们的发现。
Adsorptive granulomonocytapheresis (GMA) with the Adacolumn has been introduced as a non-pharmacologic treatment for ulcerative colitis (UC). However, a subset of patients who might respond well to GMA needs to be targeted. This study was conducted at three IBD centers to determine factors affecting the efficacy of GMA in patients with moderately-to-severely active UC. From January 2008 to December 2017, a total of 894 active episodes (first attack or relapse) in 593 patients were treated with GMA. Clinical remission was defined as normal stool frequency and no rectal bleeding. Multiple clinical and laboratory parameters at entry were considered for efficacy assessment. Clinical remission was achieved during 422 (47%) of the 894 treatment cases. In the multivariate analysis, predictors for favorable response to GMA were age ≤60 years, UC duration <1 year, Mayo endoscopic subscore 2 (vs. 3), steroid naïve UC, and biologic naïve UC. Clinical remission rate was 70% in patients with four of the five factors, 52% in patients with three factors, 46% in patients with two factors, 39% in patients with one factor, and 18% in patients with none of these factors. Overall, the clinical remission rate was significantly higher in patients with a greater number of the five predictors (P < 0.0001). GMA appeared to be effective in steroid naïve and biologic naïve patients with short duration of UC. Elderly patients (>60 years) and those with severe endoscopic activity did not respond well to GMA. Additional, well designed, prospective, controlled trials should strengthen our findings.