Efficacy and Factors Associated with Treatment Response of Intravenous Immunoglobulin in Inpatients with Refractory Inflammatory Bowel Diseases

Horton, Nicholas J.; Kochhar, Gursimran; Patel, Kajal S.; López, Rocío; Shen, Bo

doi:10.1097/mib.0000000000001116

Cited by 15 publications

(9 citation statements)

References 29 publications

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“…Intravenous immunoglobulin therapy is used for various autoimmune disorders like myasthenia gravis, systemic sclerosis, and multiple sclerosis[ 81 - 83 ]. Studies have also demonstrated therapeutic benefits of IVIG in treating refractory IBD[ 84 , 85 ].…”

Section: Drug-induced Secondary Ibdmentioning

confidence: 99%

“…This change could lead to colonic dysbiosis which plays an important role in pathogenesis of IBD[ 15 , 16 ]. In addition, there is alteration in the nutritional parameters in these individuals due to artificially induced malabsorption which could play a role in the disease process, for example vitamin D deficiency and hypoglobulinemia have been linked to pathogenesis of IBD[ 84 , 142 ]. Interestingly, when the surgery is performed in individuals with well controlled IBD, it has shown to be safe and effective, with an acceptable risk of post-operative complications[ 143 - 145 ].…”

Section: Post-surgical Secondary Ibdmentioning

confidence: 99%

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Secondary causes of inflammatory bowel diseases

Ghouri¹,

Tahan²,

Shen³

2020

WJG

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Inflammatory bowel diseases (IBD), conventionally consist of Crohn’s disease (CD) and ulcerative colitis. They occur in individuals with high risk genotype for the disease in the setting of appropriate environmental factors. The pathogenesis of IBD involves a dysregulated autoimmune response to gut dysbiosis, which in turn is triggered due to exposure to various inciting environmental factors. But there is no clearly defined etiology of IBD and this type of disease is termed as “idiopathic IBD”, “classic IBD”, or “primary IBD”. We reviewed the current medical literature and found that certain etiological factors may be responsible for the development of IBD or IBD-like conditions, and we consider this form of de novo IBD as “secondary IBD”. Currently known factors that are potentially responsible for giving rise to secondary IBD are medications; bowel altering surgeries and transplantation of organs, stem cells or fecal microbiome. Medications associated with the development of secondary IBD include; immunomodulators, anti-tumor necrosis factor alpha agents, anti-interleukin agents, interferons, immune stimulating agents and checkpoint inhibitors. Colectomy can in some cases give rise to de novo CD, pouchitis of the ileal pouch, or postcolectomy enteritis syndrome. After solid organ transplantation or hematopoietic stem cell transplantation, the recipient may develop de novo IBD or IBD flare. Fecal microbiota transplantation has been widely used to treat patients suffering from recurrent Clostridium difficile infection but can also causes IBD flares.

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Section: Drug-induced Secondary Ibdmentioning

confidence: 99%

Section: Post-surgical Secondary Ibdmentioning

confidence: 99%

Secondary causes of inflammatory bowel diseases

Ghouri¹,

Tahan²,

Shen³

2020

WJG

Self Cite

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“…Strategies aimed at reducing the production of pathogenic IgG or blocking its effector function via FcγRs, including B cell depletion, plasmapheresis, and IVIg administration, are commonly used in several inflammatory disorders but their application to IBD has not been studied extensively. No randomized control trials exist for IVIg but a meta-analysis identified a handful of case reports which indicated that IVIg can induce a rapid improvement in steroid resistant CD (272, 273), and there are reports of utility in UC (274). A single randomized controlled trial exists for the anti-CD20 antibody rituximab in UC, where the number of patients included precludes any robust conclusions (275).…”

Section: Fcγr Pathways In the Treatment Of Intestinal Diseasementioning

confidence: 99%

IgG and Fcγ Receptors in Intestinal Immunity and Inflammation

Castro‐Dopico

Clatworthy

2019

Front. Immunol.

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Fcγ receptors (FcγR) are cell surface glycoproteins that mediate cellular effector functions of immunoglobulin G (IgG) antibodies. Genetic variation in FcγR genes can influence susceptibility to a variety of antibody-mediated autoimmune and inflammatory disorders, including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). More recently, however, genetic studies have implicated altered FcγR signaling in the pathogenesis of inflammatory bowel disease (IBD), a condition classically associated with dysregulated innate and T cell immunity. Specifically, a variant of the activating receptor, FcγRIIA, with low affinity for IgG, confers protection against the development of ulcerative colitis, a subset of IBD, leading to a re-evaluation of the role of IgG and FcγRs in gastrointestinal tract immunity, an organ system traditionally associated with IgA. In this review, we summarize our current understanding of IgG and FcγR function at this unique host-environment interface, from the pathogenesis of colitis and defense against enteropathogens, its contribution to maternal-fetal cross-talk and susceptibility to cancer. Finally, we discuss the therapeutic implications of this information, both in terms of how FcγR signaling pathways may be targeted for the treatment of IBD and how FcγR engagement may influence the efficacy of therapeutic monoclonal antibodies in IBD.

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“… 32 Furthermore, the intravenous administration of immunoglobulins also seems to be efficacious in patients with IBD, suggesting that idiotype-independent effects of antibodies may play a role in VDZ treatment. 33 …”

Section: Discussionmentioning

confidence: 99%

Vedolizumab Tissue Concentration Correlates to Mucosal Inflammation and Objective Treatment Response in Inflammatory Bowel Disease

Pauwels

Proietti

Woude

et al. 2021

Inflammatory Bowel Diseases

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Background The association between vedolizumab (VDZ) exposure and treatment response is unclear and seems insufficiently explained by serum levels. The aim of this study was to assess the correlation between VDZ concentrations in serum and intestinal tissue and their association with mucosal inflammation and response to VDZ. Methods This prospective study included 37 adult patients with inflammatory bowel disease with endoscopic inflammation at baseline who started VDZ. At week 16, serum and biopsies were collected for VDZ measurement by enzyme-linked immunosorbent assay. Nonlinear mixed-effects modeling was used to calculate serum trough concentrations and to assess intestinal tissue concentrations. Validated clinical and endoscopic scores were used to define clinical and endoscopic response and remission, and fecal calprotectin levels were used to assess biochemical response. Histologic remission was determined by the Nancy score. Results A positive correlation was observed between VDZ concentrations in serum and tissue (r2 = 0.83; P < 0.0001). High mucosal rather than serum VDZ levels correlated with a reduced endoscopic (P = 0.06) grade of mucosal inflammation. Furthermore, patients with a positive biochemical and endoscopic outcome had higher tissue levels of VDZ than patients without biochemical and endoscopic response (P < 0.01 and P = 0.04, respectively). Conclusions Tissue levels of VDZ may provide a better marker than serum levels for mucosal inflammation and objective treatment outcome at week 16. The potential of VDZ tissue levels for therapeutic drug monitoring in inflammatory bowel disease warrants further exploration.

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Efficacy and Factors Associated with Treatment Response of Intravenous Immunoglobulin in Inpatients with Refractory Inflammatory Bowel Diseases

Abstract: Our study demonstrates that IVIG is beneficial in patients with medically refractory IBD, and that concomitant CDI is a risk factor for the treatment failure of IVIG for refractory disease.

Cited by 15 publications

References 29 publications

Secondary causes of inflammatory bowel diseases

Secondary causes of inflammatory bowel diseases

IgG and Fcγ Receptors in Intestinal Immunity and Inflammation

Vedolizumab Tissue Concentration Correlates to Mucosal Inflammation and Objective Treatment Response in Inflammatory Bowel Disease

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