Vedolizumab Therapy in Refractory Microscopic Colitis: A Single Center Case Series

Shipley, Lindsey C.; Ravi, Sujan; Russ, Kirk; Weber, Frederick

doi:10.1016/j.cgh.2021.02.037

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…After the removal of 67 duplicate studies, 376 studies were screened yielding 21 studies that underwent full review. Subsequently, 13 articles [18][19][20][21][22][23][24][25][26][27][28][29][30] (including four abstracts) were included in the final meta-analyses (n = 78) (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Rivière et al [27] (n = 11) reported histologic remission at 6 weeks in three patients (27.27%). Shipley et al [28] (n = 9) reported histologic follow-up for two of their patients who achieved clinical remission and found histologic remission in only one of them (duration of histologic follow-up was not reported). Two case reports [18,22] (n = 2) reported histological response in both patients.…”

Section: Histologic Remission and Responsementioning

confidence: 99%

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Efficacy and safety of biologic therapy in microscopic colitis: systematic review and meta-analysis

Taneja¹,

El-Dallal

Anand³

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Background This systematic review and meta-analysis sought to evaluate the effectiveness and safety of biologic therapy in the treatment of steroid-refractory microscopic colitis (MC). Methods We searched MEDLINE, Embase, Web of Science, and Cochrane Central to identify articles and abstracts reporting efficacy or safety data on biologic use (infliximab, adalimumab, certolizumab, golimumab, vedolizumab, ustekinumab, and tofacitinib) for induction and maintenance of remission in MC. We assessed clinical remission and response rates and all reported adverse events (AEs). Results A total of 376 studies were screened yielding 13 articles (including four abstracts) with a combined information on 78 patients for efficacy and safety outcomes. Most studies were case series. Vedolizumab was used in five studies, adalimumab in three, and a combination of infliximab and adalimumab in five studies. The rates of remission were 66.08% (95% CI, 36.79-95.37%; I 2 , 71%) at weeks 3-6 and 54.20% (95% CI, 39.39-69.01%; I 2 , 0%) at weeks 12-16. Clinical response rates were 100% (95% CI, 88.04-100%; I 2 , 0%) at weeks 3-6 and 67.20% (95% CI, 47.72-86.69%; I 2 , 52%) at weeks 12-16. Most frequent AE was medication discontinuation with a pooled incidence of 16.1% (95% CI, 5.9-37.5%). No deaths attributable to biologic use were reported. The overall quality of evidence was very low due to the high risk of biases. Conclusion Low-quality evidence supports the short-term efficacy of biologics in budesonide refractory MC. While our findings represent the most comprehensive evaluation of biologic therapy in severe MC, further research including randomized clinical trials is needed to better define the role of specific agents and long-term therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Histologic Remission and Responsementioning

confidence: 99%

Efficacy and safety of biologic therapy in microscopic colitis: systematic review and meta-analysis

Taneja¹,

El-Dallal

Anand³

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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“…After induction therapy, five out of eleven patients had entered clinical remission. Shipley et al 37 report on nine patients with MC, who all showed response to vedolizumab treatment, which could be maintained in six of them. Another case series describes three cases of MC, which were successfully treated with vedolizumab.…”

Section: Discussionmentioning

confidence: 99%

Vedolizumab blocks α4β7 integrin-mediated T cell adhesion to MAdCAM-1 in microscopic colitis

Besendorf

Müller

Geppert

et al. 2022

Therap Adv Gastroenterol

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Background: In Crohn’s disease and ulcerative colitis, the anti-α4β7 integrin antibody vedolizumab has demonstrated efficacy in phase III trials and has been successfully used under real-world conditions. Occasionally, it has also been used in other forms of inflammatory bowel disease (IBD) such as microscopic colitis (MC). However, the mechanisms of vedolizumab in MC have not been studied to date. Therefore, we aimed to investigate the expression and functional role of gut-homing integrins and in particular α4β7 integrin in a cohort study in MC. Methods: We studied the expression of gut homing integrins on T cells from patients with MC and healthy controls by flow cytometry. To investigate the function of α4β7 integrin in MC and the potential of vedolizumab to block it, we used dynamic adhesion assays and transmigrations assays. Moreover, we describe two clinical cases of MC patients treated with vedolizumab. Results: A specific profile of gut homing markers can be found on T cells from patients with MC. α4β7 integrin functionally leads to firm adhesion to MAdCAM-1 and supports transmigration. Vedolizumab is able to block both processes. In two cases of MC, we observed reduced clinical symptoms and histologic improvement upon therapy with vedolizumab. Conclusion: Our data suggest that α4β7 mediates gut homing of T cells also in MC and that, on single cell level, vedolizumab blocks the function of α4β7 in MC. Thus, we provide mechanistic evidence supporting vedolizumab as promising therapeutic option for MC.

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“…In recent years, TNF inhibitors ( Nielsen and Ainsworth, 2013 ) (infliximab and adalimumab) have been introduced for the management of microscopic colitis ( Cotter et al, 2017 ; Münch et al, 2012 ; Anderson and Makins, 2016 ; Daferera et al, 2019 ; Pola et al, 2013 ), together with the α 4 β 7 anti-integrin, vedolizumab ( Hollier et al, 2022 ; Shipley et al, 2022 ; Abu-Sbeih et al, 2018 ; Rivière et al, 2019 ) and recently the anti-IL-12/IL-23 antibody, ustekinumab ( Abughazaleh et al, 2019 ). A meta-analysis of 11 articles (four with infliximab and adalimumab, two with adalimumab, and five with vedolizumab), including 75 patients with severe microscopic colitis, showed a response rate of 77% at 3–6 weeks and 67% at 12–16 weeks, and 55% were able to achieve remission at 12–16 weeks ( Taneja et al, 2021 ).…”

Section: Treatmentmentioning

confidence: 99%

Microscopic colitis: Etiopathology, diagnosis, and rational management

Nielsen

Fernández‐Bañares

Sato

et al. 2022

eLife

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Microscopic colitis is an inflammatory bowel disease divided into two subtypes: collagenous colitis and lymphocytic colitis. With an increasing incidence of microscopic colitis exceeding those of ulcerative and Crohn’s disease among elderly people in some countries, microscopic colitis is a debilitating life experience. Therefore, physicians should be familiar with its clinical features and management strategies because the disease deserves the same attention as the classical inflammatory bowel diseases. Here, state-of-the-art knowledge of microscopic colitis is provided from a global perspective with reference to etiopathology and how to establish the diagnosis with the overall aim to create awareness and improve rational management in clinical practice. The immune system and a dysregulated immune response seem to play a key role combined with risk factors (e.g. cigarette smoking) in genetically predisposed individuals. The symptoms are characterized by recurrent or chronic nonbloody, watery diarrhea, urgency, weight loss, and a female preponderance. As biomarkers are absent, the diagnosis relies on colonoscopy with a histological assessment of biopsy specimens from all parts of the colon. Although the disease is not associated with a risk of colorectal cancer, a recent nationwide, population-based cohort study found an increased risk of lymphoma and lung cancer. Budesonide is the first-line therapy for management, whereas immunomodulatory drugs (including biologics) and drugs with antidiarrheal properties may be indicated in those failing, dependent, or intolerant to budesonide. In microscopic colitis induced by checkpoint inhibitors, a drug class used increasingly for a wide range of malignancies, a more aggressive therapeutic approach with biologics introduced early seems reasonable. However, particular attention needs to be drawn to the existence of incomplete forms of microscopic colitis with the risk of being overlooked in routine clinical settings.

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Vedolizumab Therapy in Refractory Microscopic Colitis: A Single Center Case Series

Cited by 6 publications

References 8 publications

Efficacy and safety of biologic therapy in microscopic colitis: systematic review and meta-analysis

Efficacy and safety of biologic therapy in microscopic colitis: systematic review and meta-analysis

Vedolizumab blocks α4β7 integrin-mediated T cell adhesion to MAdCAM-1 in microscopic colitis

Microscopic colitis: Etiopathology, diagnosis, and rational management

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