Abstract
BackgroundThe available information on granulocyte and monocyte adsorptive apheresis (GMA) in patients with inflammatory bowel disease (IBD) under special situations remains unclear. We conducted a retrospective, multicentre cohort study to evaluate the safety and effectiveness of GMA in patients with IBD under special situations.MethodsThis study included patients with ulcerative colitis (UC) or Crohn’s disease who had at least one special situation feature and who had received GMA between November 2013 and March 2017. The incidence of adverse events (AEs) was compared in relation to the special situation, and patient background factors related to an AE were identified. For patients with UC, clinical remission was defined as a partial Mayo score of ≤2.ResultsA total of 437 patients were included in this study. The incidence of AEs among the elderly patients (11.2%) was similar in all patients (11.4%), whereas the incidences of AEs in patients on multiple immunosuppressant medications (15.2%), patients with anaemia (18.1%) and paediatric/adolescent patients (18.9%) were higher than that in all patients (11.4%). In multivariate analysis, anaemia and concomitant immunosuppressant medications were independently associated with the incidence of AEs. Clinical remission was achieved in 46.4% of the patients with UC.ConclusionsThe incidence of AEs in the elderly patients was not higher than that in all patients, whereas the incidence of AE was higher in patients with anaemia and those on multiple immunosuppressant medications than that in all patients. GMA is a safe treatment option in elderly patients with IBD.
Highlights
The available information on granulocyte and monocyte adsorptive apheresis (GMA) in patients with inflammatory bowel disease (IBD) under special situations remains unclear
Anaemia (Hb < 10 g/dL) and concomitant immunosuppressant medications were independently associated with the incidence of adverse events (AEs)
In the multivariate analysis, a higher number of concomitant immunosuppressant medications showed an increasing trend in the Odds ratios (OR) related to AE, and we found that concomitant corticosteroids was associated with a reduced risk of AE
Summary
The available information on granulocyte and monocyte adsorptive apheresis (GMA) in patients with inflammatory bowel disease (IBD) under special situations remains unclear. It is known that the risk of opportunistic infection increases in patients with IBD on concomitant immunosuppressant medications and that it is even higher in those aged > 50 years [11, 12]. Thiopurines in elderly patients with IBD reportedly carry an increased risk of nonmelanoma skin cancer, lymphoproliferative disorder [17, 18] and opportunistic infections [19] when compared with younger patients with IBD. It has been reported that elderly patients with IBD treated with an anti-TNF agents such as infliximab, adalimumab or certolizumab pegol experience a higher incidence of severe adverse event (AE) together with treatment discontinuation as compared with younger patients [20, 21]. The bottom line derived from these observations is that extra attention is warranted to avoid increased incidences of AE when prescribing immunosuppressant medications to patients with IBD under special situations
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