The combination of granulocyte-monocyte apheresis and vedolizumab: A new treatment option for ulcerative colitis?

J Clin Apher. 2019 Dec;34(6):680-685. doi: 10.1002/jca.21746. Epub 2019 Sep 13.


Objectives: To assess the effectiveness and safety of combining granulocyte-monocyte apheresis (GMA) and vedolizumab (VDZ) in patients with refractory ulcerative colitis (UC).

Methods: This retrospective, multicentre pilot study included all UC patients receiving both GMA and VDZ. We recorded data on GMA sessions, demographic characteristics, and clinical response. Effectiveness was assessed 1 and 6 months after finishing the GMA using the partial Mayo score, C-reactive protein, and fecal calprotectin levels. Data were also compiled on VDZ intensification, use of new immunomodulators and colectomy during follow-up.

Results: Eight patients were included (mean age 46 years; 63% female; mean disease duration, 132 months; 50% E3). GMA was started after a loss of response to VDZ in all cases (25% primary nonresponse and 75% secondary loss of response). All had previously received anti-TNF agents. VDZ was prescribed as the second-, third-, or fourth-line biologic in 37%, 50%, and 13% of cases, respectively. Patients had a mean baseline partial Mayo score of 7.5 (SD 2.1) and received a median of 15 GMA sessions (range 5-38). After a median follow-up of 7.5 months (IQR 5-12), partial Mayo score decreased after 1 and 6 months (P = .01 and .06, respectively). Three patients (38%) achieved steroid-free clinical remission and five (63%) withdrew VDZ. Colectomy rate was 38%. No adverse events were observed during the combination therapy.

Conclusions: This small case series suggests that combining GMA with VDZ could be a treatment option in selected cases of UC with an inadequate response to this biologic agent.

Keywords: inflammatory bowel disease; leukapheresis; ulcerative colitis; vedolizumab.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Blood Component Removal / methods*
  • Colitis, Ulcerative / therapy*
  • Combined Modality Therapy / methods*
  • Female
  • Gastrointestinal Agents / administration & dosage
  • Granulocytes / cytology*
  • Humans
  • Male
  • Middle Aged
  • Monocytes / cytology*
  • Pilot Projects
  • Retrospective Studies
  • Treatment Outcome


  • Antibodies, Monoclonal, Humanized
  • Gastrointestinal Agents
  • vedolizumab