Successful Use of Infliximab in the Treatment of Corticosteroid Dependent Collagenous Colitis

Pola, Suresh; Sandborn, William J.; Evans, Elisabeth; Fahmy, Marianne

doi:10.1097/00054725-201212001-00036

Cited by 5 publications

(5 citation statements)

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“…In the case of steroid dependence, bismuth subsalicylate can be used before azathioprine, 6-mercaptopurine, or methotrexate. In a few reports, microscopic colitis with refractory symptoms to immunosuppressive therapy was treated successfully with antitumor necrosis factor therapies before the surgical treatment option [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Anti-PD1-induced collagenous colitis in a melanoma patient

Baroudjian¹,

Lourenço

Pagès³

et al. 2016

Melanoma Research

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Targeted immunotherapy has markedly improved the survival of melanoma patients. We report the case of a melanoma patient who developed a collagenous colitis under an anti-PD1 regimen. A 68-year-old woman was treated for a stage IV melanoma. An anti-PD1, pembrolizumab, was introduced after the failure of a first-line therapy with an anti-CTLA4. At cycle 14, pembrolizumab was interrupted because of grade 3 diarrhea. Histologic analysis of colon mucosa showed a thickened apical subepithelial collagen layer with irregular collagen deposition of more than 25 µm thickness. Budesonide 9 mg/day and cholestyramin 8 g/day were then introduced, leading to a decrease in the number of stools to grade 2. Because of the prognosis of the disease, the efficacy of pembrolizumab in this patient and the lack of other efficient treatments, pembrolizumab was restarted, with no worsening of the diarrhea after a follow-up of 8 weeks. In the era of immunotherapy, a new type of drug-induced colitis has emerged because of monoclonal antibodies targeting immune checkpoints such as CTLA-4 and PD1. Gastrointestinal tract immune-mediated adverse effects are now well described with ipilimumab. To the best of our knowledge, this is the first report of a collagenous colitis in a patient treated with pembrolizumab, thus suggesting a new mechanism of toxicity. Classically, collagenous colitis first-line treatment is based on discontinuation of the suspected treatment. However, there may be a strong benefit to maintaining an anti-PD1 regimen in our patients. In this case, symptomatic management associated with budesonide and cholestyramin enabled continuation of pembrolizumab.

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Section: Discussionmentioning

confidence: 99%

Anti-PD1-induced collagenous colitis in a melanoma patient

Baroudjian¹,

Lourenço

Pagès³

et al. 2016

Melanoma Research

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“…Very limited evidence from case series, however, suggests that immunosuppressants such as azathioprine and anti-tumor necrosis factor agents may benefit these patients. [5][6][7][8][9] We encourage prospective clinical trials to further investigate these early findings.…”

Section: Strong Moderatementioning

confidence: 94%

American Gastroenterological Association Institute Guideline on the Medical Management of Microscopic Colitis

et al. 2016

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Artículo de publicación ISIThis article has an accompanying continuing medical education activity on page e17. Learning Objective: Upon completion of this test, successful learners will be able to: (1) learn first-line treatment for the induction of remission in microscopic colitis; (2) identify the expected clinical benefits and adverse effects of induction therapy for microscopic colitis; (3) understand the indications for and dosing of maintenance therapy for microscopic colitis; (4) consider medications that may precipitate microscopic colitis especially in those who are refractory to medical therapy; and (5) become familiar with treatment strategies for microscopic colitis refractory to first-line therapy

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“…Anti-TNF agents in MC have been studied in small case series 320,321 and single cases. [322][323][324] In four MC patients with severe symptoms refractory to standard medical therapies, infliximab or adalimumab lead to long-term clinical remission in three cases (two with adalimumab and one with infliximab). One patient on adalimumab had an early loss of response and was referred for colectomy.…”

Section: Biologicsmentioning

confidence: 99%

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

et al. 2021

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Introduction Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, non-bloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder. Methods Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method. Results These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice. Conclusion These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.

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Successful Use of Infliximab in the Treatment of Corticosteroid Dependent Collagenous Colitis

Cited by 5 publications

References 0 publications

Anti-PD1-induced collagenous colitis in a melanoma patient

Anti-PD1-induced collagenous colitis in a melanoma patient

American Gastroenterological Association Institute Guideline on the Medical Management of Microscopic Colitis

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

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