潰瘍性大腸炎に対するGMAの最適化 : ワンランク上の有効性をめざしたGMA(<特集>炎症性腸疾患に対するアフェレシスの新展開)

概要

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Granulocyte/monocyte adsorptive apheresis (GMA) is reported to be an effective adjunct therapy in patients with ulcerative colitis (UC). However, the current treatment schedule is not adequate for optimizing remission rates in patients with various UC severity levels. Therefore, the efficacy of this non-drug based treatment strategy needs to be optimized. The first step is to select patients based on colonoscopic findings. Patients with an early stage UC, and steroid-naive cases without extensive or deep ulcers should be good responders. Patients with deep lesions and extensive loss of the mucosal tissue may not benefit from GMA therapy. The second approach is the treatment frequency; two GMA sessions/week should be more effective both in remission rate and time to remission as compared with one GMA session/week. The third option is to increase the processed blood volume in one GMA session. The routine processed blood volume has been 30mL/min×60min, regardless of the patient's body weight (BW), assuming that the potential GMA effect in patients with different BW is the same. We performed GMA at a higher processed blood volume, adjusted to the patients' BW (60mL/kg). This approach was superior to the routine GMA therapy for inducing clinical and endoscopic remission, and maintaining remission.
2011-02-28