J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Case Report

Volume 16, Number 5, May 2024, pages 256-263

Efficacy and Safety of Upadacitinib Plus Intensive Granulocyte and Monocyte Adsorptive Apheresis as Induction for Intractable Ulcerative Colitis

Figure 1. Clinical outcomes at baseline and 10 weeks in seven patients who completed 10-week combination therapy with UPA plus intensive GMA. Mean full Mayo scores (P < 0.03) (a), endoscopic subscores (P < 0.03) (b), and CRP concentrations (P < 0.05) (c) show significant differences between baseline and 10 weeks after analysis using the Wilcoxon signed-rank test for paired data. *P < 0.03; **P < 0.05. CRP: C-reactive protein; GMA: granulocyte and monocyte adsorptive apheresis; UPA: upadacitinib.

**Table 1.** Baseline Demographic Data of Eight Cases That Received Combination Therapy With UPA and Intensive GMA for Intractable UC
Demographic characteristics
Data are presented as mean (range) or number. CRP: C-reactive protein; GMA: granulocyte and monocyte adsorptive apheresis; UC: ulcerative colitis; UPA: upadacitinib.
Male/female, n	5/3
Age, years	46.3 (18 - 78)
Disease duration, years	13.6 (1.3 - 26)
Location of lesions, n
Extensive	2
Left-sided	5
Distal	1
Severity, n
Moderate/severe	1/7
Concomitant medications for UC, n
Corticosteroid	7
Mesalamine	7 (2: allergic)
Prior use, n
Azathioprine	1
Adalimumab	1
Full Mayo score at baseline	11.5 (9 - 12)
Endoscopic subscore at baseline	3 (3)
CRP at baseline, mg/dL	1.83 (0.03 - 5.57)

Table 1. Baseline Demographic Data of Eight Cases That Received Combination Therapy With UPA and Intensive GMA for Intractable UC

Demographic characteristics

Data are presented as mean (range) or number. CRP: C-reactive protein; GMA: granulocyte and monocyte adsorptive apheresis; UC: ulcerative colitis; UPA: upadacitinib.

Male/female, n

5/3

Age, years

46.3 (18 - 78)

Disease duration, years

13.6 (1.3 - 26)

Location of lesions, n

Extensive

Left-sided

Distal

Severity, n

Moderate/severe

1/7

Concomitant medications for UC, n

Corticosteroid

Mesalamine

7 (2: allergic)

Prior use, n

Azathioprine

Adalimumab

Full Mayo score at baseline

11.5 (9 - 12)

Endoscopic subscore at baseline

3 (3)

CRP at baseline, mg/dL

1.83 (0.03 - 5.57)

**Table 2.** Clinical Course Through 10 Weeks
No.	Age	Sex	Disease duration (years)	Disease location	Pretreated	Baseline	Treated	At 10 weeks
^aFrom Reference 19. ^bPartial Mayo scores except for endoscopic subscore, stool frequency, rectal bleeding and CRP concentration at week 4 are shown. Stool frequency subscore of Mayo score: 0: normal number of stools; 1: 1 - 2 stools more than normal; 2: 3 - 4 stools more than normal; 3: ≥ 5 stools more than normal. Rectal bleeding subscore of Mayo score: 0: no blood seen; 1: streaks of blood seen with stool less than half the time; 2: obvious blood seen with stool most of the time; 3: blood alone passed. ADA: adalimumab; AZA: azathioprine; CR: clinical remission; CRP: C-reactive protein; Endo score: endoscopic subscore; Full Mayo: full Mayo score; GMA: granulocyte and monocyte adsorptive apheresis; PSL: prednisolone; UPA: upadacitinib.
1	47	M	26	Left-sided	-	10	9	3	1	3	0.65	5.2	+	+	3	1	0	1	-	0.05	3.1	0
2	33	M	4.8	Extensive	-	40	11	3	2	3	2.43	5.2	+	+	7	2	0	3	-	0.01	5.2	0
3^a	44	F	22	Extensive	-	30	12	3	3	3	5.54	5.4	+	+	3	0	0	2	-	0.03	2A.1	0
4	39	M	21	Left-sided	-	20	12	3	3	3	0.03	5.4	+	+	1	1	0	0	+	0.01	2A.1	0
5	59	F	21	Distal	ADA, AZA	0	12	3	3	3	0.03	5.1	+	+	1	0	0	1	+	0.08	2A.2, 2B.2	0
6	52	M	3	Left-sided	-	30	12	3	3	3	0.23	5.3	+	+	1	0	0	1	+	0.03	2A.1	0
7	18	M	1.3	Left-sided	-	30	12	3	3	3	0.12	5.2	+	+	0	0	0	0	+	0.03	1.1	0
8	78	F	10	Left-sided	-	5	12	3	3	3	5.57	5.4	+	+	1^b (4 weeks)	0^b	0^b		-	0.13^b		0

Table 2. Clinical Course Through 10 Weeks

No.

Age

Sex

Disease duration (years)

Disease location

Pretreated

Baseline

Treated

At 10 weeks

Drugs

PSL (mg)

Full Mayo

Stool frequency

Rectal bleeding

Endo score

CRP (mg/dL)

Geboes score (grade)

UPA

Intensive GMA

Full Mayo

Stool frequency

Rectal bleeding

Endo score

CRP (mg/dL)

Geboes score (grade)

PSL (mg)

^aFrom Reference 19. ^bPartial Mayo scores except for endoscopic subscore, stool frequency, rectal bleeding and CRP concentration at week 4 are shown. Stool frequency subscore of Mayo score: 0: normal number of stools; 1: 1 - 2 stools more than normal; 2: 3 - 4 stools more than normal; 3: ≥ 5 stools more than normal. Rectal bleeding subscore of Mayo score: 0: no blood seen; 1: streaks of blood seen with stool less than half the time; 2: obvious blood seen with stool most of the time; 3: blood alone passed. ADA: adalimumab; AZA: azathioprine; CR: clinical remission; CRP: C-reactive protein; Endo score: endoscopic subscore; Full Mayo: full Mayo score; GMA: granulocyte and monocyte adsorptive apheresis; PSL: prednisolone; UPA: upadacitinib.

Left-sided

0.65

5.2

0.05

3.1

4.8

Extensive

2.43

5.2

0.01

5.2

3^a

Extensive

5.54

5.4

0.03

2A.1

Left-sided

0.03

5.4

0.01

2A.1

Distal

ADA, AZA

0.03

5.1

0.08

2A.2, 2B.2

Left-sided

0.23

5.3

0.03

2A.1

1.3

Left-sided

0.12

5.2

0.03

1.1

Left-sided

5.57

5.4

1^b (4 weeks)

0^b

0.13^b