Vedolizumab-Associated Acute Respiratory Distress Syndrome

Nambiar, Sudheer; Karippot, Asha; Oliver, Tony

doi:10.1097/mjt.0000000000000627

Cited by 12 publications

(12 citation statements)

References 2 publications

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“…However, in the past 4 years, 7 cases of noninfectious lung injury related to vedolizumab have been reported, including 4 cases of UC and 3 cases of CD. In 2017, Sudheer et al [ 8 ] first reported a 58-year-old white man with UC who developed acute respiratory distress syndrome requiring intubation and mechanical ventilation after receiving 3 doses of vedolizumab. By withholding vedolizumab and applying the steroid, the patient was successfully discharged home.…”

Section: Discussionmentioning

confidence: 99%

Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis: A case report

Zhang¹,

Liu²,

Gao³

et al. 2022

WJCC

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BACKGROUND Vedolizumab, a newer class of integrin antagonist biological agents, has been applied to treat patients with moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), especially for patients who are refractory to traditional therapies and tumor necrosis factor antagonists. However, some rare but life-threatening adverse effects warrant pharmacovigilance. We describe the first fatal case of vedolizumab-associated severe diffuse interstitial lung disease in China. CASE SUMMARY We present a case of new-onset diffuse parenchymal lung disease developing under treatment with vedolizumab in a patient with UC. After two doses of vedolizumab, he developed persistent fever and progressively worsening dyspnea. Extensive workups, including bronchoalveolar lavage, transbronchial lung biopsy and metagenomic next-generation sequencing, identified no infectious causes, and other potential causes (such as tumors and cardiogenic pulmonary edema) were also excluded. As a result, a diagnosis of vedolizumab-related interstitial lung disease was established. Unfortunately, although corticosteroids and empiric antibiotics were administered, the patient eventually died of respiratory failure. CONCLUSION Vedolizumab-related interstitial lung disease in patients with UC is rare but potentially lethal. Gastroenterologists and pulmonologists should be aware of vedolizumab-related adverse drug reactions.

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Section: Discussionmentioning

confidence: 99%

Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis: A case report

Zhang¹,

Liu²,

Gao³

et al. 2022

WJCC

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“…However, clinical observations indicate an increased risk for extra-intestinal autoimmune events under this therapy . There have been 2 case reports of ILD in the literature 61,62 . The only case of vedolizumab related ILD (Unclassified subtype) reported in our cohort responded to steroids but had further admissions due to flare of her disease and required golimumab therapy.…”

Section: Discussionmentioning

confidence: 99%

Interstitial and Granulomatous Lung Disease in Inflammatory Bowel Disease Patients

Eliadou

Moleiro²,

Ribaldone

et al. 2019

Journal of Crohn's and Colitis

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Background Interstitial lung [ILD] disease and granulomatous lung disease [GLD] are rare respiratory disorders that have been associated with inflammatory bowel disease [IBD]. Clinical presentation is polymorphic and aetiology is unclear. Methods This was an ECCO-CONFER project. Cases of concomitant ILD or GLD and IBD, or drug-induced ILD/GLD, were collected. The criteria for diagnosing ILD and GLD were based on definitions from the American Thoracic Society and the European Respiratory Society and on the discretion of reporting clinician. Results We identified 31 patients with ILD. The majority had ulcerative colitis [UC] [n = 22]. Drug-related ILD was found in 64% of these patients, 25 patients [80.6%] required hospitalisation, and one required non-invasive ventilation. The causative drug was stopped in all drug-related ILD, and 87% of patients received systemic steroids. At follow-up, 16% of patients had no respiratory symptoms, 16% had partial improvement, 55% had ongoing symptoms, and there were no data in 13%. One patient was referred for lung transplantation, and one death from lung fibrosis was reported. We also identified 22 GLD patients: most had Crohn’s disease [CD] [n = 17]. Drug-related GLD was found in 36% of patients and 10 patients [45.4%] required hospitalisation. The causative drug was stopped in all drug-related GLD, and 81% of patients received systemic steroids. Remission of both conditions was achieved in almost all patients. Conclusions ILD and GLD, although rare, can cause significant morbidity. In our series, over half of cases were drug-related and therefore focused pharmacovigilance is needed to identify and manage these cases.

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“…Moreover, beyond clinical remission, VDZ has been shown to induce endoscopic and histologic healing, with higher rates in UC than CD 4,6 . Overall rates of adverse events, serious adverse effects, and serious infections were not different between patients treated with placebo and those who received VDZ 5,7 . AEs reported from pooled data of clinical trials were approximately 30.6%, and mostly minor, including myalgia and arthralgia, followed by nasopharyngitis, infection, and skin infections 8 .…”

Section: What Is Known and Objectivementioning

confidence: 97%

“…4,6 Overall rates of adverse events, serious adverse effects, and serious infections were not different between patients treated with placebo and those who received VDZ. 5,7 AEs reported from pooled data of clinical trials were approximately 30.6%, and mostly minor, including myalgia and arthralgia, followed by nasopharyngitis, infection, and skin infections. 8 The exposure-adjusted incidence rates of infections…”

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confidence: 99%

Vedolizumab‐associated pulmonary manifestations in children with ulcerative colitis

Cucinotta

Dipasquale

Costa

et al. 2021

Clinical Pharmacy Therapeu

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Vedolizumab (VDZ) is a humanized monoclonal antibody and an antiintegrin molecule which interferes with lymphocytes trafficking in the inflamed gastrointestinal tract, therefore reducing immune cell infiltration and local inflammation. 1 In particular, VDZ is characterized by a gut selectivity thanks to its interaction with a4b7-integrin, which is expressed specifically by a subset of gastrointestinalhoming T lymphocytes. Such a blockade prevents the binding of a4b7-integrin-positive leukocytes to the mucosal addressing cell adhesion molecule-1 (Mad-CAM-1) and their translocation from the blood into the inflamed gastrointestinal submucosa. 1 Integrin antagonists represent a relatively new class of therapy and an attractive option for the treatment of inflammatory bowel disease (IBD) as they target different inflammatory pathways in patients who are refractory or intolerant to tumour necrosis factor (TNF)α inhibitors.In addition, they are reported to show reduced systemic side-effects due to gastrointestinal selectivity. 1 Pivotal phase-3, double-blind, placebo-controlled studies, i.e.GEMINI studies 1 and 2, have shown VDZ to be effective in inducing and maintaining clinical remission in adult ulcerative colitis (UC) and Crohn's disease (CD), respectively. 2,3 Based on these results, VDZ has been approved for the treatment of moderate-to-severe CD and UC in patients of 18 years and older who are refractory or intolerant to either conventional treatments or anti-TNFα agents. [3][4][5] The effectiveness and safety of VDZ has been assessed in several real-world studies, displaying promising results both in adult and paediatric settings. 1 Moreover, beyond clinical remission, VDZ has been shown to induce endoscopic and histologic healing, with higher rates in UC than CD. 4,6 Overall rates of adverse events, serious adverse effects, and serious infections were not different between patients treated with placebo and those who received VDZ. 5,7 AEs reported from pooled data of clinical trials were approximately 30.6%, and mostly minor, including myalgia and arthralgia, followed by nasopharyngitis, infection, and skin infections. 8 The exposure-adjusted incidence rates of infections

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Vedolizumab-Associated Acute Respiratory Distress Syndrome

Cited by 12 publications

References 2 publications

Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis: A case report

Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis: A case report

Interstitial and Granulomatous Lung Disease in Inflammatory Bowel Disease Patients

Vedolizumab‐associated pulmonary manifestations in children with ulcerative colitis

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