Therapeutic landscape for ulcerative colitis: where is the Adacolumn® system and where should it be?

Maurizio Vecchi,1 Piero Vernia,2 Gabriele Riegler,3 Renata D'Incà,4 Vito Annese,5 Siro Bagnoli51University of Milan, Department of Biomedical Sciences for Health, San Donato Milanese, Milan, 2Sapienza University of Rome, Department of Internal Medicine and Medical Specialties, Gastroenterology Unit, Rome, 3Second University of Naples, Gastroenterology and Endoscopy Unit, Naples, 4University of Padua, Department of Surgical and Gastroenterological Science, Gastroenterology Unit, Padua, 5University Hospital Careggi, Gastroenterology Unit, Florence, ItalyAbstract: Granulocyte-monocyte apheresis is a relatively new therapy that has been proposed, sometimes with controversial results, for the treatment of inflammatory bowel disease, particularly ulcerative colitis. The aim of the present study was to perform a thorough review of the literature on the application of this type of treatment in ulcerative colitis and discuss the results, in order to provide an opinion on its use which is shared by the involved experts. The review of the literature was performed by searching PubMed with appropriate key words. The results obtained suggest that the major role for this treatment at this moment is for those patients with steroid dependency or with major contraindications to use of steroids. However, promising, albeit very preliminary, results have also been observed in steroid-naïve subjects, and this is of particular interest in consideration of the safety profile of this therapeutic method. As such, the Adacolumn may prove useful in specific subgroups of patients. Future phenotypic, genotypic, and molecular characterization of patients with inflammatory bowel disease might prove useful in defining better those subjects who might benefit most from this treatment modality.Keywords: ulcerative colitis, inflammatory bowel disease, guidelines, apheresis