PT  - JOURNAL ARTICLE
AU  - Kiss, Szabolcs
AU  - Németh, Dávid
AU  - Hegyi, Péter
AU  - Földi, Mária
AU  - Szakács, Zsolt
AU  - Erőss, Bálint
AU  - Tinusz, Benedek
AU  - Hegyi, Péter Jenő
AU  - Sarlós, Patrícia
AU  - Alizadeh, Hussain
TI  - Granulocyte and monocyte apheresis as an adjunctive therapy to induce and maintain clinical remission in ulcerative colitis: a systematic review and meta-analysis
AID  - 10.1136/bmjopen-2020-042374
DP  - 2021 May 01
TA  - BMJ Open
PG  - e042374
VI  - 11
IP  - 5
4099  - http://bmjopen.bmj.com/content/11/5/e042374.short
4100  - http://bmjopen.bmj.com/content/11/5/e042374.full
SO  - BMJ Open2021 May 01; 11
AB  - 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.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).