Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.12998/wjcc.v9.i13.3219 http://hdl.handle.net/11449/210285 |
Resumo: | BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. CASE SUMMARY A 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 mu g/mL) and fecal calprotectin of 921 mu g/g (< 30 mu g/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy. CONCLUSION Infliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients. |
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Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case reportInfliximabAcute severe ulcerative colitisToxic megacolonUlcerative colitisInflammatory bowel diseaseCase reportBACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. CASE SUMMARY A 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 mu g/mL) and fecal calprotectin of 921 mu g/g (< 30 mu g/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy. CONCLUSION Infliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients.Sao Paulo State Univ Unesp, Med Sch, Dept Internal Med, Av Prof Mario Rubens Guimaraes Montenegro S-N, BR-18618687 Botucatu, SP, BrazilClin Univ Los Andes, Med Dept, Gastroenterol, Inflammatory Bowel Dis Program, Santiago 7550000, ChileSao Paulo State Univ Unesp, Med Sch, Dept Internal Med, Av Prof Mario Rubens Guimaraes Montenegro S-N, BR-18618687 Botucatu, SP, BrazilBaishideng Publishing Group IncUniversidade Estadual Paulista (Unesp)Clin Univ Los AndesSousa de Vasconcelos Garate, Ana Lorena [UNESP]Rocha, Thiara Barcelos [UNESP]Almeida, Luciana Rocha [UNESP]Quera, RodrigoBarros, Jaqueline Ribeiro [UNESP]Baima, Julio Pinheiro [UNESP]Saad-Hossne, Rogerio [UNESP]Sassaki, Ligia Yukie [UNESP]2021-06-25T15:03:40Z2021-06-25T15:03:40Z2021-05-06info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article3219-3226http://dx.doi.org/10.12998/wjcc.v9.i13.3219World Journal Of Clinical Cases. Pleasanton: Baishideng Publishing Group Inc, v. 9, n. 13, p. 3219-3226, 2021.2307-8960http://hdl.handle.net/11449/21028510.12998/wjcc.v9.i13.3219WOS:000645608800030Web of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengWorld Journal Of Clinical Casesinfo:eu-repo/semantics/openAccess2024-08-14T17:22:13Zoai:repositorio.unesp.br:11449/210285Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-14T17:22:13Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
title |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
spellingShingle |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report Sousa de Vasconcelos Garate, Ana Lorena [UNESP] Infliximab Acute severe ulcerative colitis Toxic megacolon Ulcerative colitis Inflammatory bowel disease Case report |
title_short |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
title_full |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
title_fullStr |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
title_full_unstemmed |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
title_sort |
Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report |
author |
Sousa de Vasconcelos Garate, Ana Lorena [UNESP] |
author_facet |
Sousa de Vasconcelos Garate, Ana Lorena [UNESP] Rocha, Thiara Barcelos [UNESP] Almeida, Luciana Rocha [UNESP] Quera, Rodrigo Barros, Jaqueline Ribeiro [UNESP] Baima, Julio Pinheiro [UNESP] Saad-Hossne, Rogerio [UNESP] Sassaki, Ligia Yukie [UNESP] |
author_role |
author |
author2 |
Rocha, Thiara Barcelos [UNESP] Almeida, Luciana Rocha [UNESP] Quera, Rodrigo Barros, Jaqueline Ribeiro [UNESP] Baima, Julio Pinheiro [UNESP] Saad-Hossne, Rogerio [UNESP] Sassaki, Ligia Yukie [UNESP] |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) Clin Univ Los Andes |
dc.contributor.author.fl_str_mv |
Sousa de Vasconcelos Garate, Ana Lorena [UNESP] Rocha, Thiara Barcelos [UNESP] Almeida, Luciana Rocha [UNESP] Quera, Rodrigo Barros, Jaqueline Ribeiro [UNESP] Baima, Julio Pinheiro [UNESP] Saad-Hossne, Rogerio [UNESP] Sassaki, Ligia Yukie [UNESP] |
dc.subject.por.fl_str_mv |
Infliximab Acute severe ulcerative colitis Toxic megacolon Ulcerative colitis Inflammatory bowel disease Case report |
topic |
Infliximab Acute severe ulcerative colitis Toxic megacolon Ulcerative colitis Inflammatory bowel disease Case report |
description |
BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. CASE SUMMARY A 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 mu g/mL) and fecal calprotectin of 921 mu g/g (< 30 mu g/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy. CONCLUSION Infliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-25T15:03:40Z 2021-06-25T15:03:40Z 2021-05-06 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.12998/wjcc.v9.i13.3219 World Journal Of Clinical Cases. Pleasanton: Baishideng Publishing Group Inc, v. 9, n. 13, p. 3219-3226, 2021. 2307-8960 http://hdl.handle.net/11449/210285 10.12998/wjcc.v9.i13.3219 WOS:000645608800030 |
url |
http://dx.doi.org/10.12998/wjcc.v9.i13.3219 http://hdl.handle.net/11449/210285 |
identifier_str_mv |
World Journal Of Clinical Cases. Pleasanton: Baishideng Publishing Group Inc, v. 9, n. 13, p. 3219-3226, 2021. 2307-8960 10.12998/wjcc.v9.i13.3219 WOS:000645608800030 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
World Journal Of Clinical Cases |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
3219-3226 |
dc.publisher.none.fl_str_mv |
Baishideng Publishing Group Inc |
publisher.none.fl_str_mv |
Baishideng Publishing Group Inc |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
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1808128110537736192 |