Award: Presidential Poster Award
Courtney Perry, DO1, Marijeta Pekez, MD1, Praneeth Kudaravalli, MD2, Mahmoud Hashim, MD2, Olalekan Akanbi, MD2, Pradeep Yarra, MD2, Terrence Barrett, MD1
1University of Kentucky, Lexington, KY; 2University of Kentucky College of Medicine, Lexington, KY
Introduction: Microscopic colitis (MC) is a chronic inflammatory disease of the colon that is responsible for up to 10-15% of chronic watery diarrhea (Cotter TG, Binder M, Loftus EV, et al. Gut 2018). While this disease is often self-limiting, some patients suffer from severe disease that can be refractory to standard medical therapies, such as Imodium and budesonide. These patients are often referred to tertiary care facilities for initiation of anti-tumor necrosis factor agents (anti-TNFs) as they have shown some benefit in refractory disease. However, a significant side effect profile does accompany these agents which can make their use less desirable. Vedolizumab, a monoclonal human antibody to α4β7-integrin that blocks lymphocyte trafficking to the gut, has an excellent safety profile (Battat R, Ma C, et all. Drug Safety 2019) and is an appealing option for patients with severe refractory MC.
Case Description/Methods: Three patients presenting to the University of Kentucky with severe microscopic colitis refractory to maximum budesonide and Imodium therapy were treated with vedolizumab. Vedolizumab was given at standard induction dosing (300mg IV at week 0, 2 and 6, and then every 8 weeks). Clinical remission was defined as < 3 stools a day following induction of vedolizumab with ability to wean budesonide.
Discussion: All three patients had remission of their MC as evidenced by cessation of diarrhea and ability to wean budesonide and Imodium after induction vedolizumab, including one patient who had suffered from microscopic colitis for over 20 years.This case series supports the small number of case reports that have surfaced in publications over the past 18 months, the largest of which consisted of 11 patients. While the definitive mechanism of microscopic colitis remains unknown, one of the proposed mechanisms details activation of CD8 T suppressor cells in the IEC and NF-ƙβ pathway activation leading to tissue damage in epithelial cells and barrier dysfunction (Gentile N, Yen E. Gut Liver 2018). The efficacy of vedolizumab in inducing MC remission supports this proposed mechanism, given its mechanism of action to bind α4β7-integrin and prevent T-cell adhesion. Larger scale clinical trials are needed to support routine clinical use of vedolizumab in refractory microscopic colitis, but this drug presents a promising, low-side effect profile treatment option for MC suffers.
Citation: Courtney Perry, DO; Marijeta Pekez, MD; Praneeth Kudaravalli, MD; Mahmoud Hashim, MD; Olalekan Akanbi, MD; Pradeep Yarra, MD; Terrence Barrett, MD. P0173 - VEDOLIZUMAB-INDUCED REMISSION OF REFRACTORY MICROSCOPIC COLITIS: A SINGLE INSTITUTION CASE SERIES. Program No. P0173. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.