Article Text
Abstract
Objective The goal of treatment in ulcerative colitis (UC) is to induce and maintain remission. The addition of granulocyte and monocyte apheresis (GMA) to conventional therapy may be a promising therapeutic alternative. In this meta-analysis, we aimed to assess the efficacy and safety profile of GMA as an adjunctive therapy.
Design Systematic review and meta-analysis.
Methods We searched four databases (MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials) for randomised or minimised controlled trials which discussed the impact of additional GMA therapy on clinical remission induction and clinical remission maintenance compared with conventional therapy alone. Primary outcomes were clinical remission induction and maintenance, secondary outcomes were adverse events (AEs) and steroid-sparing effect. ORs with 95% CIs were calculated. Trial Sequential Analyses were performed to adjusts for the risk of random errors in meta-analyses.
Results A total of 11 studies were eligible for meta-analysis. GMA was clearly demonstrated to induce and maintain clinical remission more effectively than conventional therapy alone (598 patients: OR: 1.93, 95% CI 1.28 to 2.91, p=0.002, I2=0.0% for induction; 71 patients: OR: 8.34, 95% CI 2.64 to 26.32, p<0.001, I2=0.0% for maintenance). There was no statistically significant difference in the number of AEs (OR: 0.27, 95% CI 0.05 to 1.50, p=0.135, I2=84.2%).
Conclusion GMA appears to be more effective as an adjunctive treatment in inducing and maintaining remission in patients with UC than conventional therapy alone.
PROSPERO registration number CRD42019134050.
- inflammatory bowel disease
- immunology
- gastroenterology
- haematology
Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request (alizadeh.hussain@pte.hu).
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request (alizadeh.hussain@pte.hu).
Supplementary materials
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Footnotes
Contributors All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript. SK: drafting the manuscript, selection of studies, data extraction, risk of bias assessment; DN: statistical analysis, preparation of the standardised data collection sheet, drafting the manuscript; PH: substantial contribution in study design, critical revision of the content; MF: selection of studies, data extraction, risk of bias assessment, drafting the manuscript; ZS: participation in the design of the study and its coordination, critical revision of the manuscript; BE: provided revisions to the scientific content of the manuscript, substantial contribution in design of the work; BT: substantial contribution in study design, drafting the manuscript; PJH: preparation of the standardised data collection sheet, stylistic and grammatical revision of the manuscript, substantial contribution in study design; PS: expert in the field of gastroenterology, substantial contribution in study design and interpretation of data, preparation of study protocol and the first draft of the manuscript; HA: expert in the field of haematology, substantial contribution in study design and interpretation of data, preparation of study protocol and the first draft of the manuscript.
Funding This research was not a company-initiated study. All costs were covered by the Economic Development and Innovation Operative Programme Grant (GINOP 2.3.2-15-2016-00048), the Grant of the Hungarian Science Foundation (FK 132834) and by Human Resources Development Operational Programme Grants (EFOP-3.6.2-16-2017-00006). Sponsors were not involved in the design, data collection, analysis, interpretation or preparation of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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