Combination of granulocyte-monocyte apheresis and tofacitinib: Multicentre and retrospective study

Gastroenterol Hepatol. 2024 Aug-Sep;47(7):727-733. doi: 10.1016/j.gastrohep.2024.01.004. Epub 2024 Jan 23.
[Article in English, Spanish]

Abstract

Objective: Granulocyte-monocyte apheresis (GMA) has shown to be safe and effective in treating ulcerative colitis (UC), also in combination with biologics. The objective of this study is to evaluate the efficacy and safety of combining GMA after primary non-response (PNR) or loss of response (LOR) to tofacitinib (TOFA) in patients with UC.

Patients and methods: Retrospective study including all patients with refractory UC who received GMA plus TOFA. Efficacy was assessed 1 and 6 months after finishing GMA by partial Mayo score, C-reactive protein (CRP) and fecal calprotectin (FC). Descriptive statistics and non-parametric tests were used in the statistical analysis.

Results: Twelve patients were included (median 46 years [IQR, 37-58]; 67% female; 67% E3). Patients were mostly receiving TOFA 10mg bid (75%), and 33% also concomitant steroids at baseline. Median partial Mayo score at baseline was 7 (IQR, 5-7), and it decreased to a median of 2 (IQR, 0-3) and 0 (IQR, 0-3) after 1 and 6 months (p=0.027 and 0.020, respectively), while no differences were found in CRP and FC. Clinical remission was achieved by 6 patients both at 1 (50%) and 6 months (67%). CF values<250mg/kg were achieved by 2 and 4 patients at 1 and 6 months (data available in 5 and 7 patients, respectively). No patient required dose-escalation of TOFA, and one patient was able to de-escalate the drug. No patient required colectomy and all patients under steroids were able to stop them.

Conclusion: The combination of GMA and TOFA can be effective in selected cases of UC after PNR or LOR to this drug.

Keywords: Aféresis de granulocitos-monocitos; Colitis ulcerosa; Enfermedad inflamatoria intestinal; Granulocyte–monocyte apheresis; Inflammatory bowel disease; Tofacitinib; Ulcerative colitis.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • C-Reactive Protein / analysis
  • Colitis, Ulcerative* / drug therapy
  • Colitis, Ulcerative* / therapy
  • Combined Modality Therapy
  • Female
  • Granulocytes*
  • Humans
  • Leukapheresis / methods
  • Male
  • Middle Aged
  • Monocytes*
  • Piperidines* / administration & dosage
  • Piperidines* / therapeutic use
  • Protein Kinase Inhibitors / therapeutic use
  • Pyrimidines* / therapeutic use
  • Pyrroles / administration & dosage
  • Pyrroles / therapeutic use
  • Retrospective Studies
  • Treatment Outcome

Substances

  • tofacitinib
  • Pyrimidines
  • Piperidines
  • Pyrroles
  • C-Reactive Protein
  • Protein Kinase Inhibitors