RT Journal Article
SR Electronic
T1 Granulocyte and monocyte apheresis as an adjunctive therapy to induce and maintain clinical remission in ulcerative colitis: a systematic review and meta-analysis
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e042374
DO 10.1136/bmjopen-2020-042374
VO 11
IS 5
A1 Kiss, Szabolcs
A1 Németh, Dávid
A1 Hegyi, Péter
A1 Földi, Mária
A1 Szakács, Zsolt
A1 Erőss, Bálint
A1 Tinusz, Benedek
A1 Hegyi, Péter Jenő
A1 Sarlós, Patrícia
A1 Alizadeh, Hussain
YR 2021
UL http://bmjopen.bmj.com/content/11/5/e042374.abstract
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).