• Anti-tumor necrosis factor-α antibody
• Combination therapy
• Cytapheresis
• Granulocyte and monocyte adsorptive apheresis
• Inflammatory bowel disease
• Ulcerative colitis

• Biological Products/adverse effects
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/drug therapy
• Cytapheresis
• Humans
• Immunologic Factors/therapeutic use
• Remission Induction
• Steroids/therapeutic use
• Treatment Outcome

The etiology and pathogenesis of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, are not fully understood so far. Therefore, IBD still remains incurable despite the fact that significant progress has been achieved in recent years in its treatment with innovative medicine. About 20 years ago, selective granulocyte and monocyte apheresis (GMA) was invented in Japan and later approved by the Japanese health authority for IBD treatment. From then on this technique was extensively used for IBD patients in Japan and later in Europe. Clinical trials from Japan and European countries have verified the effectiveness and safety of GMA therapy in patients with IBD. In 2013, GMA therapy was approved by China State Food and Drug Administration for therapeutic use for the Chinese IBD patients. However, GMA therapy has not been extensively used in China, although a few clinical studies also showed that it was effective in clinical and endoscopic induction of remission in Chinese IBD patients with a high safety profile. This article reviews past history, present clinical application as well as the future prospective of GMA therapy for patients with IBD.

• Inflammatory bowel disease
• Ulcerative colitis
• Crohn’s disease
• Granulocyte and monocyte apheresis
• Therapy
• Efficacy

• Ulcerative colitis
• anti-TNF agents
• granulocyte–monocyte apheresis
• loss of response

• Crohn's disease
• Granulocyte monocyte apheresis
• Inflammatory bowel disease
• Ulcerative colitis

The goals of treatment for active Crohn’s disease (CD) are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF)-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin α4 and α4β7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis.

• adalimumab
• combination therapy
• complete remission
• granulocyte and monocyte adsorptive apheresis

Adalimumab (ADA) is applied to induce remission in patients with Crohn's disease (CD) naïve to chimeric anti-tumor necrosis factor-α (anti-TNF-α), infliximab or patients with loss of response to scheduled maintenance infliximab. Adsorptive granulocyte and monocyte apheresis (GMA) depletes elevated/activated myeloid lineage leucocytes as sources of inflammatory cytokines and has been used to treat patients with CD. This study was to investigate the efficacy of intensive GMA in combination with ADA as remission induction therapy in cases of CD refractory to medications including anti-TNF-α therapies. Between December 2010 and February 2012, 5 consecutive cases with refractory CD were treated with intensive GMA (2 sessions per week) plus ADA to induce remission. CD activity index (CDAI), C-reactive protein (CRP), and endoscopic findings based on the simple endoscopic score for CD (SES-CD) at baseline and 10 weeks post 5 ADA injections were applied to determine treatment efficacy outcomes. At week 10 post ADA treatment, clinical remission together with normal CRP levels were achieved in all 5 cases, while SES-CD scores reflected marked improvement in 3 cases and partial improvement in 2 cases who had extensive deep longitudinal CD lesions. The CDAI and CRP values at baseline were 324 ± 118 and 4.9 ± 3.3 mg/dl, respectively. The corresponding values after treatment were 100 ± 28 (p = 0.024) and 0.2 ± 0.2 mg/dl (p = 0.038). In these 5 cases with medication-refractory CD, combination therapy with intensive GMA followed by 5 ADA shots appeared to be an effective and safe intervention for inducing clinical remission.

• Adalimumab
• Clinical remission
• Intensive adsorptive granulocyte and monocyte apheresis
• Refractory Crohn's disease
• Simple endoscopic score for Crohn's disease

• Adalimumab
• Chronic myeloid leukemia
• Crohn’s disease
• Intensive granulocyte and monocyte adsorptive apheresis

• Adalimumab
• Antibodies, Monoclonal, Humanized/therapeutic use
• Colonoscopy
• Combined Modality Therapy
• Crohn Disease/drug therapy
• Crohn Disease/therapy
• Granulocytes
• Humans
• Immunosuppressive Agents/administration & dosage
• Immunosuppressive Agents/therapeutic use
• Leukapheresis
• Leukocyte Reduction Procedures
• Male
• Mercaptopurine/administration & dosage
• Mercaptopurine/therapeutic use
• Mesalamine/administration & dosage
• Mesalamine/therapeutic use
• Metronidazole/administration & dosage
• Metronidazole/therapeutic use
• Monocytes
• Parenteral Nutrition, Total
• Prednisolone/administration & dosage
• Prednisolone/therapeutic use
• Remission Induction
• Young Adult