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People with severe alcohol-associated hepatitis who are not responsive to or intolerant of conventional treatments may experience improved survival benefits at 90 and 180 days with the use of granulocyte-monocyte/macrophage apheresis.
In a prospective, open-label, nonrandomized study, granulocyte-monocyte/macrophage apheresis (GMA) demonstrated a lower-than-expected 90- and 180-day mortality compared to published studies in patients suffering from steroid-nonresponsive or steroid-intolerant severe alcohol-associated hepatitis. Researchers sought to examine whether GMA use improves survival rates in severe alcohol-associated hepatitis.
Hepatitis-affected individuals, identified as nonresponsive or intolerant to corticosteroids based on the Lille model and Model for End-stage Liver Disease (MELD) score criteria, and fulfilling specific inclusion criteria (such as leukocytosis over 10,000/μL), were contemplated for recruitment. Following the standard of care, subjects were included with a median duration of 23 days (interquartile range [IQR], 14-31 days) from admission. The efficiency of GMA using Adacolumn, conducted twice per week for up to ten sessions per treatment course, was examined.
A total of 13 GMA treatments were executed in this pilot study. At the time of admission, the Maddrey Discriminant Function was 53.2 ± 17.7. As found, the overall survival rate at 90 and 180 days was 90.9%. Following GMA, there was a remarkable betterment in MELD scores, decreasing from a median (IQRs) of 23 (20-25) to 15 (13-21) (p<0.0001). The anticipated mortality risks, examined utilizing the Lille model and MELD scores, also considerably improved from 20.9%±16.5% to 7.4%±7.3% at two months and from 30.4%±21.3% to 11.6%±10.8% at six months, respectively (both p<0.01), with internal validation.
The alcohol relapse cumulative rate was 35.9% per year. There were no severe noxious events documented. In the exploratory assessment, granulocyte colony-stimulating factor levels exhibited a pivotal correlation with prognostic systems like MELD-Sodium scores following GMA (correlation coefficient= -0.9943, p<0.0001) but not before GMA (p=0.62). Hence, GMA could serve as a potentially beneficial salvage anti-inflammatory therapy for severe alcohol-associated hepatitis patients who do not respond well to conventional treatments.
Hepatology Communications
Granulocyte-monocyte/macrophage apheresis for steroid-nonresponsive or steroid-intolerant severe alcohol-associated hepatitis: A pilot study
Ryosuke Kasuga et al.
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