PMID- 28203278
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 1756-283X (Print)
IS  - 1756-2848 (Electronic)
IS  - 1756-283X (Linking)
VI  - 10
IP  - 2
DP  - 2017 Feb
TI  - Efficacy of granulocyte and monocyte apheresis for antibiotic-refractory 
      pouchitis after proctocolectomy for ulcerative colitis: an open-label, 
      prospective, multicentre study.
PG  - 199-206
LID - 10.1177/1756283X16679348 [doi]
AB  - BACKGROUND: Granulocyte and monocyte apheresis (GMA) has shown therapeutic 
      efficacy in active ulcerative colitis (UC). We thought that in patients with 
      pouchitis after proctocolectomy for UC, GMA might produce immunological effects 
      in the intestinal mucosa, and improve clinical symptoms. This prospective study 
      was to evaluate the efficacy of GMA for antibiotic-refractory pouchitis after 
      proctocolectomy for UC. METHODS: A total of 13 patients with pouchitis disease 
      activity index (PDAI) > 7 unresponsive to 2 weeks of antibiotic therapy were 
      included. All patients received 10 GMA sessions at 2 sessions/week over 5 
      consecutive weeks. The primary endpoints were response (a decrease of ⩾3 points 
      in the PDAI) and remission (PDAI < 4). Secondary endpoints included reduction of 
      white blood cells (WBCs), C-reactive protein (CRP), faecal markers (calprotectin 
      and lactoferrin), reduction of the PDAI endoscopic subscore, and GMA safety. 
      RESULTS: The median PDAI score was significantly decreased from 11 (range, 9-15) 
      at entry to 9 (range, 6-13) after the GMA therapy (p = 0.02). A total of six 
      patients (46%) responded to the treatment, but none achieved remission. The 
      median endoscopic subscore (maximum: 6) was 5 (range, 4-6) at entry and 5 (range, 
      1-6) after the treatment (p = 0.10). None of the laboratory markers (WBCs, CRP, 
      faecal calprotectin and lactoferrin) significantly changed during the treatment. 
      Transient adverse events (AEs) were observed in two patients (15%), dyspnoea in 
      one and headache in one. The AEs were not serious, and all patients completed the 
      10 GMA sessions. CONCLUSIONS: GMA has a good safety profile, but its efficacy 
      appears to be limited in the management of chronic refractory pouchitis. However, 
      a large controlled study should be conducted to evaluate the efficacy of GMA 
      therapy in patients with pouchitis at an earlier clinical stage, before the 
      disease has become refractory to conventional medical therapy.
FAU - Yamamoto, Takayuki
AU  - Yamamoto T
AD  - Department of Surgery & Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical 
      Centre, Yokkaichi, Japan.
FAU - Tanaka, Toshiaki
AU  - Tanaka T
AD  - Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
FAU - Yokoyama, Tadashi
AU  - Yokoyama T
AD  - Department of Surgery, Yokoyama Hospital for Gastroenterological Diseases 
      (current affiliation: Yokoyama IBD Clinic), Nagoya, Japan.
FAU - Shimoyama, Takahiro
AU  - Shimoyama T
AD  - Department of Surgery & Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical 
      Centre, Yokkaichi, Japan.
FAU - Ikeuchi, Hiroki
AU  - Ikeuchi H
AD  - Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 
      Nishinomiya, Japan.
FAU - Uchino, Motoi
AU  - Uchino M
AD  - Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 
      Nishinomiya, Japan.
FAU - Watanabe, Toshiaki
AU  - Watanabe T
AD  - Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 
      Tokyo 113-0033, Japan.
LA  - eng
PT  - Journal Article
DEP - 20161125
PL  - England
TA  - Therap Adv Gastroenterol
JT  - Therapeutic advances in gastroenterology
JID - 101478893
PMC - PMC5298477
OTO - NOTNLM
OT  - antibiotics
OT  - granulocyte and monocyte apheresis
OT  - pouchitis
OT  - proctocolectomy
OT  - ulcerative colitis
COIS- Conflict of interest statement: Tadashi Yokoyama received consultancy fees and 
      research funding from EA Pharmaceuticals Co. Ltd. (Tokyo, Japan). Takayuki 
      Yamamoto, Toshiaki Tanaka, Takahiro Shimoyama, Hiroki Ikeuchi, Motoi Uchino and 
      Toshiaki Watanabe have no conflict of interest to disclose.
EDAT- 2017/02/17 06:00
MHDA- 2017/02/17 06:01
PMCR- 2017/02/01
CRDT- 2017/02/17 06:00
PHST- 2017/02/17 06:00 [entrez]
PHST- 2017/02/17 06:00 [pubmed]
PHST- 2017/02/17 06:01 [medline]
PHST- 2017/02/01 00:00 [pmc-release]
AID - 10.1177_1756283X16679348 [pii]
AID - 10.1177/1756283X16679348 [doi]
PST - ppublish
SO  - Therap Adv Gastroenterol. 2017 Feb;10(2):199-206. doi: 10.1177/1756283X16679348. 
      Epub 2016 Nov 25.