Vedolizumab作为卡铂-吉西他滨诱发的急性严重溃疡性结肠炎发作的拯救疗法

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY
R. Pellegrino, M. Fasano, F. Morgillo, Giovanna Palladino, Isabella Vassallo, M. Pirozzi, G. Imperio, Salvatore Auletta, Andrea Ventura, I. Panarese, Alessandro Federico, A. Gravina
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引用次数: 0

摘要

大约20%的溃疡性结肠炎(UC)患者发展为急性重症UC(ASUC),通常会进行静脉全身类固醇治疗和可能的英夫利昔单抗抢救治疗。然而,ASUC没有关于vedolizumab作为这种情况下的替代品的重要指南建议。一份病例报告显示,一名类固醇依赖性UC患者在二线化疗诱导下出现ASUC。采用静脉注射甲基强的松龙治疗,但在入院后几天内排便没有减少。因肿瘤病史,禁止使用英夫利昔单抗进行抢救性治疗。开始进行外科会诊、禁忌症结肠切除术和300mg维多利珠单抗给药。输注vedolizumab后,从输注后第二天开始,排便显著减少,直到三天内排便正常,同时炎症指数正常。该患者目前处于临床缓解期,每两周接受一次108 mg的维多利珠单抗皮下治疗,并正在接受肺部肿瘤的肿瘤学随访。该病例突出了韦多利珠单抗作为ASUC可能的挽救疗法的新潜力,特别是在特殊人群中,它可能提供更好的安全性。尽管环孢菌素和英夫利昔单抗仍然是类固醇难治性ASUC抢救治疗的主要支柱,但新的治疗剂也可能有效,如维多利珠单抗、ustekinumab和抗Janus激酶剂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Vedolizumab as Rescue Therapy in Carboplatin-Gemcitabine-Induced Triggered Acute Severe Ulcerative Colitis Flare-Up
Approximately 20% of patients with ulcerative colitis (UC) develop acute severe UC (ASUC), for which intravenous systemic steroid therapy and possibly infliximab-based rescue therapy are generally imposed. However, there are no significant guideline recommendations on ASUC regarding vedolizumab as an alternative in this setting. A case report was presented where a patient with steroid-dependent UC developed ASUC induced by second-line chemotherapy. Treatment with intravenous methylprednisolone was imposed, but there was no reduction in bowel movements in the days following admission. Rescue therapy with infliximab was contraindicated because of the oncologic history. Surgical consultation, contraindicated colectomy, and administration of vedolizumab 300 mg were initiated. After infusion with vedolizumab, there was a significant reduction in bowel movements starting the day after infusion until normalisation of bowel movements within three days and the concomitant normalisation of inflammatory indices. The patient is currently in clinical remission, on therapy with vedolizumab 108 mg subcutaneously every two weeks, and is in oncologic follow-up for pulmonary neoplasm. This case highlights the novel potential of vedolizumab as a possible rescue therapy in ASUC, especially in special populations, where it may offer a better safety profile. Although cyclosporine and infliximab still represent the mainstays of salvage therapy for steroid-refractory ASUC, new therapeutic agents may also be effective, such as vedolizumab, ustekinumab, and anti-Janus kinase agents.
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CiteScore
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