Efficacy and safety of vedolizumab as a treatment option for moderate to severe refractory ulcerative colitis in two patients after liver transplant due to primary sclerosing cholangitis

Martín, Raúl Vicente Olmedo; Trillo, Víctor Manuel Amo; Grande, Rocío González; Pérez, Miguel Jiménez

doi:10.17235/reed.2017.5024/2017

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…After the first review process of all the titles, 11 articles were considered as full text. Of these, eight studies matched the inclusion/exclusion criteria and were finally included 10–17 . All studies were published between 2016–2018.…”

Section: Resultsmentioning

confidence: 99%

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Safety of vedolizumab in liver transplant recipients: A systematic review

Spadaccini¹,

Aghemo

Caprioli

et al. 2019

UEG Journal

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Background The management of inflammatory bowel disease in patients who have previously undergone liver transplantation can be a clinical challenge. There are serious concerns among physicians regarding the use of biologics for treating such immuno-compromised patients. Objective We performed a systematic review on vedolizumab therapy in transplant recipients to assess its safety. Methods PubMed/Embase/Scopus were searched up to November 2018 to identify papers regarding liver transplant recipients and therapy with vedolizumab. Primary outcomes were adverse events. Secondary outcomes were liver transplant and inflammatory bowel disease outcomes. Results Eight studies (31 patients) were included. Nine out of 31 patients experienced an infection within a mean follow-up time ranging from 5–20 months. No malignancies were reported. Inflammatory bowel disease clinical response was experienced by 20/26 patients. Abnormalities in liver tests were recorded in 2/22 patients. Conclusion Vedolizumab may be considered safe for treating inflammatory bowel disease in liver transplant recipients. Caution is recommended for patients with an unstable liver graft function.

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Section: Resultsmentioning

confidence: 99%

“…Of these, eight studies matched the inclusion/exclusion criteria and were finally included. 10–17 All studies were published between 2016–2018. The study origins were as follows: six studies were from Europe (25 patients), and the remains were from Australia (five patients) and from Argentina (one patient).…”

Section: Resultsmentioning

confidence: 99%

Safety of vedolizumab in liver transplant recipients: A systematic review

Spadaccini¹,

Aghemo

Caprioli

et al. 2019

UEG Journal

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“…Vedolizumab is a humanized IgG1 monoclonal antibody that selectively blocks the lymphocyte integrin α4β7 and prevents its interaction with endothelial adhesion molecules and subsequent transmigration to the gastrointestinal tract. The drug was approved in 2014 for the induction and maintenance treatment of UC and moderate to severe CD that is refractory or intolerant to conventional therapy [ 41 ]. It has been found to be an effective first-line agent in treating moderate to severe UC [ 42 ].…”

Section: Anti-inflammatory Biologicsmentioning

confidence: 99%

Anti-Inflammatory Biologics and Anti-Tumoral Immune Therapies-Associated Colitis: A Focused Review of Literature

et al. 2018

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An increasing number of drugs including monoclonal antibodies and small molecules, either anti-inflammatory or immunity-enhancing, have been developed to treat human diseases and the number of medications in these classes is likely to expand in the future. The two most commonly used categories of such therapies are the anti-inflammatory group (anti- tumor necrosis factor (TNF) α, anti-interleukins/interleukin receptors, and anti-integrin bodies) and the anti-tumoral agents (immune checkpoint inhibitors, anti-CD20, and anti-endothelial growth factor). Although the anti-inflammatory biologics have brought about a revolutionary effect in the management of a variety of autoimmune disorders including rheumatologic diseases, inflammatory bowel disease, and inflammatory dermatological diseases, their ability to induce colitis in patients without a prior history of colitis or exacerbate quiescent colitis has been increasingly and unexpectedly recognized. While the use of immune-augmenting monoclonal antibody therapies results in a significant survival benefit in a subset of patients with malignancies, these monoclonal antibodies also have the ability to cause colitis through an apparent autoimmune mechanism. Colitis associated with these medications may demonstrate multiple histologic patterns including increased apoptosis (graft versus host disease (GVHD)-like), autoimmune enteropathy pattern, acute colitis pattern, ischemic colitis, inflammatory bowel disease pattern, either ulcerative colitis-like, Crohn’s disease-like, or fulminant colitis-like. In addition, anti-inflammatory biologics are known to cause or reactivate latent infections such as tuberculosis and increase the risk for malignancies including high-grade lymphomas as well as indolent lymphoproliferative disorders. Thus, the differential diagnosis for colitis in patients receiving therapeutic anti-inflammatory biologics or anti-tumoral agents can be broad. Optimal diagnosis and treatment requires a multidisciplinary approach. This review aims to provide an overview of the literature on the clinical features, histology, and treatment of these newly recognized anti-inflammatory biologic and anti-tumoral immune therapy-induced colitises and hopes this outlines will raise the vigilance of all clinicians of these entities.

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