Current pharmacologic treatment paradigms for inflammatory bowel disease and the potential role of granulocyte/monocyte apheresis

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Authors: Schwartz, 1; Ferguson, R.1

Source: Current Medical Research and Opinion, Volume 23, Number 11, November 2007 , pp. 2715-2728(14)

Abstract:Background: A broad range of pharmacologic therapies are available to treat active inflammatory bowel disease (IBD), including 5-aminosalicylate preparations, corti costeroids, and immunosuppressants (e.g., azathio prine/6-mercaptopurine [AZA/6-MP] or methotrexate). Although these therapies are effective, up to 60% of patients are refractory or intolerant. Biologic therapies, such as the anti-TNF agent infliximab, offer promise but are not without controversy; despite many positive reports, steroid-refractory patients are less likely than other individuals to respond to infliximab. Effective, long-term therapies that do not add to the adverse-effects burden in patients with IBD are needed. Of these, granulocyte/monocyte apheresis (GMA) is one promising approach. Scope: PubMed and relevant congresses databases were searched using the terms 'granulocyte/monocyte apheresis,' 'GMA,' 'leukocytapheresis,' 'Adacolumn,' and 'Cellsorba.' These studies were further selected to include only those focusing on IBD. A time frame of 2000-2006 was used. Findings: Data from open-label trials show that patients with moderate-to-severe IBD refractory to conventional pharmacologic treatment achieved clinical response and/or remission after treatment with GMA. Furthermore, recent small open-label trials of GMA show increased rates of induction and maintenance of response/remission in steroidnaïve IBD patients. Conclusions: The remission rates seen in these open-label clinical trials of GMA are consistent with those of currently available pharmacologic therapies for IBD. However, the majority of these trials enrolled only small numbers of patients, were largely open-label, and were of limited duration. These data must be confirmed in well-controlled, large-scale clinical trials.

Keywords: ADACOLUMN; CROHN'S DISEASE; SELECTIVE LEUKOCYTE APHERESIS; ULCERATIVE COLITIS

Document Type: Review article

DOI: 10.1185/030079907X233241

Affiliations: 1: Vanderbilt University Medical Center, Nashville, TN, USA