Systematic Review: Granulocyte / Monocyte Adsorptive Apheresis for Ulcerative Colitis

Sangeetha Thanaraj (1) , P John Hamlin (1) , Alexander Ford (1)

1 Leeds Gastroenterology Institute

Background: Patients with ulcerative colitis (UC) that is chronically active despite 5-aminosalicylates or immunomodulators, or who are dependent on corticosteroids to maintain remission, have limited treatment options. Granulocyte/monocyte adsorptive apheresis (GMAA) may have a role in this situation. Aim: To conduct a systematic review of GMAA in UC. Methods: MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched to identify randomised controlled trials (RCTs) comparing GMAA with conventional medical therapy, sham procedure, or "intensive" with "conventional" GMAA regimens in adult UC patients. Studies reported clinical remission or response rates. Formal meta-analysis was not undertaken due to concerns about methodological quality of identified studies. Results: Ten RCTs were eligible. Compared with medical therapy, remission rates with GMAA were generally higher, and corticosteroid-sparing effects were observed. Compared with sham procedure, GMAA did not achieve significantly higher remission rates. "Intensive" GMAA regimens demonstrated generally higher remission rates, and time to remission was shorter compared with "conventional" regimens. Only two RCTs were at low risk of bias. Six were conducted in Japanese patients, which may limit generalisability. Conclusions: GMAA appears of some benefit in UC. High-quality RCTs comparing GMAA with conventional medical therapy or sham procedure in Western populations are required.

Mots clés: Medicine

Sangeetha Thanaraj, P John Hamlin, Alexander Ford. Systematic Review: Granulocyte / Monocyte Adsorptive Apheresis for Ulcerative Colitis. Alimentary Pharmacology and Therapeutics, 2010, 32 (11-12), pp.1297. ⟨10.1111/j.1365-2036.2010.04490.x⟩. ⟨hal-00585782⟩