Selective granulocyte–monocyte apheresis during induction with vedolizumab in moderate–severe ulcerative colitis: Experience in a tertiary hospital

Abstract

Aim

Granulocyte and monocyte apheresis (GMA) is a potential therapeutic option when combined with various drugs for treatment of ulcerative colitis (UC). In this study, we analyze the efficacy and safety of GMA combined with vedolizumab (VDZ) during induction in patients with moderate–severe UC and incomplete response to steroids.

Patients and methods

Single-center retrospective review of patients receiving GMA + VDZ. Data on the disease and previous treatments were collected. Clinical response was classified as no response, response without remission, and remission. Available data on biochemical and endoscopic response were included. Adverse events (AEs) were recorded.

Results

The study population comprised 6 patients with UC who had received GMA + VDZ during induction after failure of an anti-TNF agent. The median number of GMA sessions was 5 (IQR 4–5; 3–10). All the patients received VDZ 300 mg iv at 0, 2, and 6 weeks, and 5 (83%) received an additional dose at week 10. During maintenance, all the patients continued VDZ iv every 8 weeks. The median follow-up was 57.6 months (IQR: 39–74). Four of the 6 patients achieved clinical remission after GMA + VDZ and continued in deep remission until the end of follow-up. A median, non-significant decrease of 1378 μg/g (IQR: 924–5778 μg/g) was observed for calprotectin and 42.2 mg/l (IQR: 15.3–113.5) for CRP vs. baseline. No patient underwent colectomy. No treatment-related AEs were observed.

Conclusions

GMA + VDZ during induction can be effective and safe in selected patients with moderate–severe UC and partial response to steroids.