Treatment of CGD-associated Colitis with the IL-23 Blocker Ustekinumab

Butte, Manish J.; Park, K. T.; Lewis, David B.

doi:10.1007/s10875-016-0318-x

Cited by 25 publications

(13 citation statements)

References 10 publications

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“…87 The use of systemic immunosuppressive medications, such as ustekinumab or vedolizumab, continues to be explored in patients with CGD colitis and has had varying effects to date. [88][89][90] TNFinhibitors should be avoided in patients with CGD, as they have been associated with serious bacterial and fungal infections and increased mortality. 91…”

Section: Management Of Infectious and Granulomatous Complicationsmentioning

confidence: 99%

<p>Geographic Variability and Pathogen-Specific Considerations in the Diagnosis and Management of Chronic Granulomatous Disease</p>

Prince¹,

Thielen²,

Williams³

et al. 2020

PHMT

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Chronic granulomatous disease (CGD) is a rare but serious primary immunodeficiency with varying prevalence and rates of X-linked and autosomal recessive disease worldwide. Functional defects in the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex predispose patients to a relatively narrow spectrum of bacterial and fungal infections that are sometimes fastidious and often difficult to identify. When evaluating and treating patients with CGD, it is important to consider their native country of birth, climate, and living situation, which may predispose them to types of infections that are atypical to your routine practice. In addition to recurrent and often severe infections, patients with CGD and X-linked female carriers are also susceptible to developing many non-infectious complications including tissue granuloma formation and autoimmunity. The DHR-123 oxidation assay is the gold standard for making the diagnosis and it along with genetic testing can help predict the severity and prognosis in patients with CGD. Disease management focuses on prophylaxis with antibacterial, antifungal, and immunomodulatory medications, prompt identification and treatment of acute infections, and prevention of secondary granulomatous complications. While hematopoietic stem-cell transplantation is the only widely available curative treatment for patients with CGD, recent advances in gene therapy may provide a safer, more direct alternative.

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Section: Management Of Infectious and Granulomatous Complicationsmentioning

confidence: 99%

<p>Geographic Variability and Pathogen-Specific Considerations in the Diagnosis and Management of Chronic Granulomatous Disease</p>

Prince¹,

Thielen²,

Williams³

et al. 2020

PHMT

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“…Anti-TNFα agents are associated with a significant risk of severe infections [23] and therefore generally avoided in these patients. Ustekinumab, anti-IL-12/IL-23 agent, has been used in CGD-associated colitis with symptomatic improvement, but its use in the reported case was discontinued due to an infection, with recurrence of colitis symptoms [24]. e use of anti-IL-1 anakinra demonstrated mixed findings in regards to treatment of CGD-associated colitis.…”

mentioning

confidence: 88%

Variable Presentation of the CYBB Mutation in One Family, Approach to Management, and a Review of the Literature

Гаврилова

Zelig

Lee

2020

Case Reports in Medicine

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Chronic granulomatous disease (CGD) is a primary immunodeficiency disorder marked by abnormal phagocytic function. CGD affects primarily neutrophils and manifests as an early predisposition to severe life-threatening infections. Additionally, patients with CGD are predisposed to unique autoimmune manifestations. While generally spared from infectious complications, heterozygous carriers of the abnormal genes implicated in CGD pathogenesis can still present with autoimmune disorders. A mutation in the CYBB gene is the only X-linked variant of this disease. This article describes a family with the CYBB mutation, its heterogenous presentation, and reviews the literature discussing disease management.

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“…Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative complications above that of CD patients treated with anti-TNF medications. In addition, it was used to treat chronic granulomatous disease-associated colitis, common variable immunodeficiency-associated IBD, chronic refractory pouchitis, and paradoxical UC developed during adalimumab treatment of psoriasis [ 30 - 33 ].…”

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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Treatment of CGD-associated Colitis with the IL-23 Blocker Ustekinumab

Cited by 25 publications

References 10 publications

<p>Geographic Variability and Pathogen-Specific Considerations in the Diagnosis and Management of Chronic Granulomatous Disease</p>

<p>Geographic Variability and Pathogen-Specific Considerations in the Diagnosis and Management of Chronic Granulomatous Disease</p>

Variable Presentation of the CYBB Mutation in One Family, Approach to Management, and a Review of the Literature

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

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