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 13, Number 10-11, November 2021, pages 510-514

Combination Therapy With Ustekinumab Plus Intensive Granulocyte and Monocyte Adsorptive Apheresis in Patients With Refractory Ulcerative Colitis

Figure 1. Evolution of mean full Mayo scores (a) and CRP (b) at baseline and 10 weeks in the four cases. Data are presented as mean ± standard error of the mean, and comparisons were made using Wilcoxon signed-rank tests. A significant level of 0.05 was used for all statistic tests, and two-tailed tests were applied as appropriate. CRP: C-reactive protein.

Figure 2. Evolution of mean endoscopic subscore at baseline and 10 weeks in the four cases. Data are presented as mean ± standard error of the mean, and comparisons were made using Wilcoxon signed-rank tests. A significant level of 0.05 was used for all statistic tests, and two-tailed tests were applied as appropriate.

**Table 1.** Baseline Demographic Variables of the Four Cases With UC Refractory to Medications Including TAC Who Were Selected for This Combination Therapy With UST Plus Intensive GMA
Demographic variables
Data are presented as mean values. UC: ulcerative colitis; TAC: tacrolimus; UST: ustekinumab; GMA: granulocyte and monocyte adsorptive apheresis; CRP: C-reactive protein.
Male/female (N)	2/2
Age (years)	45
Mean disease duration (years)	9.0 (0.3 - 15)
Location of lesions (N)
Extensive	2
Left-sided	2
Severity (N)
Moderate/severe	1/3
Concomitant medications for UC (N)
Corticosteroids	4
Mesalamine	4
TAC	1
Prior use (N): anti-TNF-α antibodies	0
Full Mayo score at baseline	11 (10 - 12)
Endoscopic subscore at baseline	2.5 (2 - 3)
CRP at baseline (mg/dL)	1.7

Table 1. Baseline Demographic Variables of the Four Cases With UC Refractory to Medications Including TAC Who Were Selected for This Combination Therapy With UST Plus Intensive GMA

Demographic variables

Data are presented as mean values. UC: ulcerative colitis; TAC: tacrolimus; UST: ustekinumab; GMA: granulocyte and monocyte adsorptive apheresis; CRP: C-reactive protein.

Male/female (N)

2/2

Age (years)

Mean disease duration (years)

9.0 (0.3 - 15)

Location of lesions (N)

Extensive

Left-sided

Severity (N)

Moderate/severe

1/3

Concomitant medications for UC (N)

Corticosteroids

Mesalamine

TAC

Prior use (N): anti-TNF-α antibodies

Full Mayo score at baseline

11 (10 - 12)

Endoscopic subscore at baseline

2.5 (2 - 3)

CRP at baseline (mg/dL)

1.7

**Table 2.** Clinical Courses Within 10 Weeks for the Four Cases
No.	Age	Sex	Disease duration (years)	Disease location	Pretreated	Baseline	Treated	At 10 weeks
TAC: tacrolimus; PSL: prednisolone; CRP: C-reactive protein; UST: ustekinumab; GMA: granulocyte and monocyte adsorptive apheresis; CR: clinical remission.
1	50	M	7	Left-sided	TAC	5	10	3	1.74	+	+	1	1	+	0.03	0
2	50	F	15	Left-sided	-	5	11	2	4.23	+	+	1	1	+	0.04	0
3	46	M	0.3	Extensive	-	20	11	3	0.42	+	+	5	2	-	0.18	0
4	33	F	14	Extensive	-	20	12	3	0.41	+	+	3	2	-	0.06	0

Table 2. Clinical Courses Within 10 Weeks for the Four Cases

No.

Age

Sex

Disease duration (years)

Disease location

Pretreated

Baseline

Treated

At 10 weeks

Previous treatment

PSL (mg)

Full Mayo

Endo scores

CRP (mg/dL)

UST

Intensive GMA

Full Mayo

Endo scores

CRP (mg/dL)

PSL (mg)

TAC: tacrolimus; PSL: prednisolone; CRP: C-reactive protein; UST: ustekinumab; GMA: granulocyte and monocyte adsorptive apheresis; CR: clinical remission.

Left-sided

TAC

1.74

0.03

Left-sided

4.23

0.04

0.3

Extensive

0.42

0.18

Extensive

0.41

0.06