Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report

Detalhes bibliográficos
Autor(a) principal: Sousa de Vasconcelos Garate, Ana Lorena [UNESP]
Data de Publicação: 2021
Outros Autores: 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]
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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spelling 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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