Vedolizumab is a gut-selective monoclonal antibody approved for the management of Crohn’s disease and ulcerative colitis. The available data demonstrate a favourable response to dose escalation in ...patients with primary non-response or secondary loss of response to vedolizumab. While therapeutic drug monitoring has a proven clinical utility for tumour necrosis factor antagonists, the available guidance for therapeutic drug monitoring and dose escalation of vedolizumab is rather limited. The present review proposes a practical algorithm to use vedolizumab trough levels in the management of treatment failure. Therapeutic drug monitoring can differentiate underexposed patients from those with mechanistic failure. Underdosed patients can respond to dose escalation instead of unnecessarily switching to other treatment modalities. We also review the safety and potential cost-effectiveness of vedolizumab dose escalation, the role of antidrug antibodies and the possible applicability of this strategy to subcutaneous vedolizumab.
SARS-CoV-2-triggered lymphocytic colitis Nassar, Islam Osama; Langman, Gerald; Quraishi, Mohammed Nabil ...
BMJ case reports,
08/2021, Letnik:
14, Številka:
8
Journal Article
Recenzirano
Odprti dostop
The ability of SARS-CoV-2 to infect the gastrointestinal tract is well described. Inflammatory bowel diseases (IBD) are believed to represent a disorganised immune response in genetically predisposed ...individuals, which are triggered by various environmental factors, notably infections. Here we report a case of chronic watery diarrhoea that was triggered by a SARS-CoV-2 infection. The work-up confirmed a new diagnosis of lymphocytic colitis, and the patient responded favourably to a course of oral budesonide. Clinicians should become vigilant to the possibility of triggered IBD in patients with persistent diarrhoea following a SARS-CoV-2 infection.
Abstract
Background
Anti-TNFα is the first class of biologics approved for treatment of moderate-to-severely active Inflammatory Bowel Disease (IBD). More than two decades on, anti-TNFs remain one of ...the most commonly used biologics for both Ulcerative Colitis (UC) and Crohn’s Disease (CD), and often as first-line therapy. Although effective, they cause several adverse events (AEs), sometimes requiring withdrawal of therapy. We aimed to record AEs and understand factors that could predict risk of AEs.
Methods
All IBD patients exposed to anti-TNF therapy were identified from EMR at two centres of a large tertiary hospital between January 2009 and June 2022. All relevant demographic and clinical data were collected for those patients with well recorded AEs and follow-up. Data on cumulative AEs directly attributed to anti-TNFs that ranged from mild reactions to serious AEs (defined as those requiring review/withdrawal of anti-TNF), were collected. Adverse events (AEs) were recorded as per relevant systems involved e.g.- haematological, cardiac etc., including infections and malignancies as separate categories. All analysis (normalization, hypothesis testing, and visual reports were performed using R software package Version: R 4.2.1.
Results
A total of 844 IBD patients (Male =408) were included with an age range of 18-75yrs. Majority were Caucasian in ethnicity (514) and more patients with CD 605(71%) were exposed to anti-TNF than UC. The age profiling analysis was performed across ethnic groups (Asian, Caucasian and Others). Age associated AE was reported across all the groups (data not shown). It must be mentioned that though not significant, Caucasian patients were more susceptible towards AE as compared to Asian.
Conclusion
· Patient age above 50yrs has a strong predictive risk factor for AEs related to anti-TNF therapy for IBD.
· In our cohort, more than half of patients >50yrs reported at least one AE in UC, and the age was lower in CD.
· Although Caucasians were more vulnerable to AEs, this was not statistically significant.
· Clinicians should consider and discuss this risk before selecting patients for anti-TNF therapy.
· With multiple biologic choices currently available, another class could be considered where possible, for the >50yr patient cohort.
Letter: faecal microbiota transplantation for IBS Segal, Jonathan P.; Mullish, Benjamin H.; Quraishi, Mohammed Nabil ...
Alimentary pharmacology & therapeutics,
August 2020, 2020-08-00, 20200801, Letnik:
52, Številka:
3
Journal Article
Recenzirano
Odprti dostop
LINKED CONTENT
This article is linked to Lahtinen et al papers. To view these articles, visit
https://doi.org/10.1111/apt.15810 and https://doi.org/10.1111/apt.15875.
The aim of this systematic review and meta-analysis is to assess the efficacy and safety of faecal microbiota transplantation FMT in the treatment of chronic pouchitis.
A PRISMA-compliant systematic ...review and meta-analysis was conducted using the following databases and clinical trial registers: Medline, Embase, Scopus, Cochrane Database of Systematic Reviews CENTRAL, clinical trials.gov, ScienceDirect, and VHL virtual health library. The primary outcome was clinical response/remission in patients treated with FMT. Secondary outcomes included safety profile, quality of life, and changes in the gut microbiome.
Seven observational cohort studies/case series and two randomised, controlled trials with a total of 103 patients were included. The route, preparation, and quantity of FMT administered varied among the included studies. Clinical response rate of 42.6% with a remission rate of 29.8% was estimated in our cohort following FMT therapy. Minor, self-limiting, adverse events were reported, and the treatment was well tolerated with good short- and long-term safety profiles. Successful FMT engraftment in recipients varied and, on average, microbial richness and diversity was lower in patients with pouchitis. In some instances, shifts with specific changes towards abundance of species, suggestive of a 'healthier' pouch microbiota, were observed following treatment with FMT.
The evidence for FMT in the treatment of chronic pouchitis is sparse, which limits any recommendations being made for its use in clinical practice. Current evidence from low-quality studies suggests a variable clinical response and remission rate, but the treatment is well tolerated, with a good safety profile. This review emphasises the need for rationally designed, well-powered, randomised, placebo-controlled trials to understand the efficacy of FMT for the treatment of pouchitis.
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