Twenty-four-week follow-up examination of a leukocytapheresis therapy in rheumatoid arthritis

Safety and efficacy of the leukocytapheresis procedure in eighty-five patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disease in which the predominant symptom is polyarthritis that follows a chronic and progressive clinical course characterized by destructive synovitis and various immune disorders. Striking progress in RA treatment was achieved with the emergence of monoclonal antibodies to target cytokines. However, drug choices are limited for many patients due to resistance to multidrug antirheumatic therapy, concomitant disease, and infection. We evaluated the efficacy of treatment in 85 patients with RA for whom leukocytapheresis (LCAP) was initiated at our hospital between 2006 and 2015. All patients continued drug therapy and were treated with LCAP once a week for up to 5 weeks. The clinical response was evaluated at the completion of LCAP series and 4 weeks later using the American College of Rheumatology (ACR) criteria and the 28-joint disease activity score (DAS28) of European League Against Rheumatism (EULAR). The tender joint counts, swollen joint counts, and C-reactive protein (CRP) levels decreased remarkably. DAS28-CRP was significantly improved by LCAP. And furthermore, the efficacy lasted at least 4 weeks after the completion of LCAP. These results suggest that LCAP is a beneficial and are consistent with several trials' reported effect of LCAP. This treatment can contribute to improvements in activities of daily living (ADLs) and long-term outcome by improving swollen and tender joint counts and CRP levels even in refractory patients for whom the use of conventional disease-modifying antirheumatic drugs (DMARDs) and biopharmaceuticals is problematic. LCAP might be a promise therapy to refractory RA.

Recruitment of immature neutrophils in peripheral blood following leukocytapheresis therapy for rheumatoid arthritis

The objective of this study is to evaluate the cellular mechanism underlying filtration leukocytapheresis (LCAP) therapy for the treatment of rheumatoid arthritis (RA). Thirteen patients with refractory RA each underwent three sessions of LCAP. Before (pre-) and after (post-) the completion of the first LCAP session, peripheral blood was sampled and analyzed for neutrophil surface markers using flow cytometry. The surface antigens of peripheral blood mononuclear cells (PBMCs) and neutrophils obtained at pre- and post-LCAP were then analyzed using a fluorescence-activated cell sorter. The American College of Rheumatology's criterion of a 20% improvement was achieved in six patients, but not in the other seven patients, after LCAP therapy. The post-LCAP number of blood band form neutrophils with a bone marrow phenotype (CD49d(dim+), low density) was higher among the responders than among the nonresponders, suggesting an association between the clinical response and the recruitment of bone-marrow-derived neutrophils. After the nonspecific absorption of WBCs during a 1-h Cellsorba procedure, the number of PBMCs was consistently decreased, although the number of neutrophils that were affected by removal plus recruitment varied in a manner that was independent of efficacy. In contrast, the emergence of immature neutrophils in the peripheral blood was characteristic of the effective therapies. These cells were found after the 1st session of responders and also found following sessions of LCAPs. Immature neutrophils, which may be recruited from the bone marrow in the peripheral blood after the first session of LCAP, can predict the clinical efficacy of subsequent LCAP sessions.

Enhanced effect of high-dose leukocytapheresis using a large filter in rheumatoid arthritis

To evaluate the efficacy of high-dose leukocytapheresis (LCAP) using a large filter in patients with refractory rheumatoid arthritis (RA), we conducted a multicenter, nonrandomized, open-label clinical study. Thirty patients with highly active RA were treated with high-dose LCAP performed 3-5 sessions at 1-week intervals using a CS-180S filter (CS-180S group); the treatment involves the removal of leukocytes from a higher blood volume per body weight (100;Sml/kg). The clinical response was evaluated at 4 and 8 weeks after a series of LCAP using the 28-joint disease activity score (DAS28). Similar data of 53 patients treated with conventional LCAP (60;Sml/kg) using a standard filter, CS-100, were compared as a control (CS-100 group). The CS-180S filter demonstrated a higher adsorption capacity for leukocytes, particularly lymphocytes. The CS-180S group exhibited significant improvements in each item of DAS28 after treatment although the CS-100 group did not demonstrate such improvements in the CRP level and the ESR. Compared to the CS-100 group, the patients of the CS-180S group exhibited a tendency toward improvement with respect to the CRP level and ESR (P = 0.057 and 0.041, respectively). According to the EULAR improvement criteria based on DAS28, 60% and 45% of the patients from CS-180S and CS-100 groups achieved moderate or more responses, respectively, at 4 weeks after treatment. These results suggest that compared to conventional LCAP, high-dose LCAP may enhance the suppression of RA disease activity.

Improved response to infliximab after leukocytapheresis in a patent with rheumatoid arthritis

This is the first report on effective leukocytapheresis (LCAP) in an acquired infliximab (IFM) resistant patient with rheumatoid arthritis (RA). A 44-year-old Japanese woman with RA was treated with prednisolone, cyclosporine A, and methotrexate, which failed to stabilize the disease. Infliximab was then administered and the disease activity was controlled on December 2003. However, RA became active again on June 2004 so that LCAP was administered weekly for 5 weeks. After the LCAP treatment, the ACR20% response was obtained again and IFM has regained its efficacy.