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Vedolizumab in Refractory Microscopic Colitis: An International Case Series
Katholieke Univ Leuven, Belgium.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
Gastroenterol La Source Beaulieu, Switzerland.
Western Univ, Canada.
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2019 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no 3, p. 337-340Article in journal (Refereed) Published
Abstract [en]

Background Evidence for second-line therapy in patients with microscopic colitis [MC] failing budesonide is scarce, although anti-tumour necrosis factors [anti-TNFs], methotrexate and azathioprine have been reported to be effective in small cohort studies. Vedolizumab, a monoclonal antibody targeting 47-integrin, prevents homing of T-cells to the gut. We evaluated clinical remission with vedolizumab in budesonide-refractory MC patients. Methods We solicited gastroenterologists in Europe and Canada for cases of MC treated with vedolizumab. Vedolizumab 300 mg IV was administered at weeks 0, 2 and 6, and then every 8 weeks. Clinical remission and histological remission were defined as less than three stools per day and normalization of histology, respectively, after induction treatment. Results Eleven cases were retrieved (nine females, lymphocytic colitis [LC] n = 5, collagenous colitis [CC] n = 6). Median [interquartile range] disease duration at vedolizumab initiation was 51 [29-70] months. Nine of 11 patients had failed one immunosuppressant and ten of 11 at least one anti-TNF agent. After three infusions of vedolizumab, clinical remission was observed in 5/11 patients [two LC and three CC] of whom three remained well with maintenance therapy [median duration of 13 months]. Biopsies were obtained from 9/11 patients. Histological remission was observed in 3/4 patients with clinical remission [2/3 CC, 1/1 LC] and 0/5 patients without clinical improvement. Conclusion In a series of highly refractory MC patients, vedolizumab induced clinical remission in 5/11 subjects, of whom 75% showed normalized histology. Larger randomized trials are needed to assess the efficacy of vedolizumab in patients with MC.

Place, publisher, year, edition, pages
Oxford University Press, 2019. Vol. 13, no 3, p. 337-340
Keywords [en]
microscopic colitis; refractory; vedolizumab; treatment outcome
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-157266DOI: 10.1093/ecco-jcc/jjy169ISI: 000464942000010PubMedID: 30329034Scopus ID: 2-s2.0-85063950086OAI: oai:DiVA.org:liu-157266DiVA, id: diva2:1323833
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-06-17Bibliographically approved

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Münch, Andreas

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Division of Neuro and Inflammation ScienceFaculty of Medicine and Health SciencesDepartment of Gastroentorology
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