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In patients with moderate UC with recurrent high-risk factors, videlizumab escalation achieves rapid relief
of ulcerative colitis (UC) in six weeks, characterized by recurrent inflammation confined to the colonic mucosal layer, often involving the rectum, and may spread proximal continuously to other parts of the colon [1].
。 Clinical remission, endoscopic remission and maintenance remission are the core links of UC treatment, and the improvement of these indicators can effectively relieve patients' symptoms, improve quality of life and reduce complications [2].
Vedelizumab is a humanized monoclonal antibody that inhibits the interaction between leukocytes and the intestinal vasculature by blocking the binding of α4β7 integrin to the intestinal mucosal selective cell adhesion molecule 1 (MAdCAM-1), selectively blocking the flow of inflammatory cells to the diseased intestine[3].
。 Several studies have shown that vedelizumab is safe and effective in inducing clinical remission and hormone-free remission in active UC, and also has a good long-term effect in refractory UC [4-6].
This issue invites Dr.
Xin Yu, Department of Gastroenterology, Second Hospital of Shandong University, to share a classic case to see how a patient with recurrent active moderate UC can achieve clinical benefits
through vedelizumab.
About
the author Xin Yu
Attending physician, Department of Gastroenterology, Second Hospital of Shandong University
Graduated from Peking Union Medical College
Studied under Professor Qian Jiaming
He presided over 1 Natural Science Foundation of Shandong Province and participated in 2 Natural Science Foundation of Shandong Province
Published several SCI papers and co-edited Harrison Gastroenterology and Hepatology Chinese Translated Edition.
He is good at the diagnosis and treatment of inflammatory bowel disease and the mechanism of inflammatory bowel disease cancer
Classic case
stool for 4 years and aggravated for 5 months".
▌Present medical history:
The patient began to have pus and blood stool after eating spicy food 4 years ago, once a day, no abdominal pain, fever, no rash and joint swelling and pain, the use of antibacterial drugs, the effect is not good, the frequency of stool is increased than before, pus and blood stool 2-3 times a day, with abdominal pain, paroxysmal, left lower quadrant is significant, abdominal pain relief after defecation, no fever, no nausea, vomiting, colonoscopy in our hospital UC (total colonic type, left hemicolon type), pathology: (ileocec, sigmoid colon) mucosal chronic active inflammation with erosion and glandular fossa abscess formation, Combined with clinically consistent UC, mesalazine 1g was given four times a day (QID) treatment, and the symptoms improved
.
The patient had repeated symptoms 3 years ago, and he was treated with mesalazine 1g QID and rehabilitation solution again, and his symptoms improved, and then the drug was gradually reduced to discontinuation
.
Before 5 months, the patient had repeated pus and bloody stools, stool 4 times a day, self-administration of mesalazine treatment and Chinese medicine treatment, the frequency of stool was slightly reduced, there was still pus and blood and abdominal pain, in order to seek further diagnosis and treatment, the outpatient department was admitted to the ward
with "UC".
▌Auxiliary examination: blood routine:
white blood cells (WBC) 3.
51×109/L, Percentage of neutrophils (NEUT%) 45.
2%, hemoglobin (HGB) 127g/L, platelet (PLT) 189×109/L, C-reactive protein (CRP) < 1.
0mg/L, erythrocyte sedimentation rate (ESR) 4mm/h; </b112> Stool routine + occult blood + calprotectin : (descending colon) sent for detection of very small superficial mucosal chronic inflammation.
Case summary
This case is a patient with moderate UC, with repeated pus and bloody stools with abdominal pain and diarrhea for 4 years, and the condition relapses after treatment with mesalazine, and repeat colonoscopy shows ulcerative colitis (E2, Mayo score 3).
With vedelizumab combined with mesalazine, the patient's symptoms gradually improved
.
After 6 cycles of vedelizumab 300 mg, repeat colonoscopy showed almost mucosal healing, the Mayo score was reduced to 1 point, and vedelizumab treatment was effective
.
After communication with the patient, the continued use of vedelizumab monotherapy in the later stage is maintained
.
Expert reviews
UC is a chronic, progressive disease, and approximately 44 percent of patients with UC present with a chronic, persistent or recurrent course [7].
With the advent of the era of biologics, there are more and more clinical drug options for UC, so how to standardize treatment on the basis of comprehensive assessment of the condition and full informed consent of patients is very important
.
After detailed examination of the diagnosis and treatment of the patient in this case, it was found that the patient was less than 40 years old and had a medical history of up to four years
.
Although the effect of previous treatment with mesalazine was acceptable, the disease has been recurrent
.
By the time of this admission, it had developed moderate UC, endoscopicly showing severely active lesions with ulcers, and the Mayo endoscopic score was 3 points
.
Data from epidemiological and clinical studies suggest that extensive lesions (E3), severe endoscopic lesions (relatively large, patchy ulcers, Mayo internal mirror score of 3), high inflammatory burden (CRP≥30 mg/L, ESR≥ 30 mm/h), and prolonged ulcers or recurrent disease are high-risk factors affecting disease progression in UC patients [8].
The prediction of high-risk factors for disease progression can help to strengthen UC treatment
at an early stage.
Therefore, a comprehensive evaluation reveals that the patient in this case has multiple risk factors
for disease progression.
For UC patients with multiple risk factors for disease progression, the treatment strategy should be: early, aggressive, thorough, and maintained
.
In terms of treatment options, the American Gastrointestinal Association (AGA) states that biologics should be used early to improve clinical outcomes in patients with moderate/severe UC, especially those at high risk of disease progression [9].
Vedelizumab is currently the only enteric selective biologic in the field of inflammatory bowel disease [10], which is used in the treatment of patients with moderate/severe UC, and has the advantages
of high tolerance, long-lasting action [11], high safety [12] and economic benefits [13].
In this case, after the standardized treatment of vedelizumab in the treatment regimen, the patient's symptoms improved significantly, the mucosal healing showed good on colonoscopy, and the Mayo endoscopic score dropped to 1 point
.
Through this case, we can experience that for patients with moderate UC who are also associated with high-risk factors, the use of biologics with good efficacy, high safety and economic benefits can be prioritized to quickly relieve symptoms while achieving mucosal healing, thereby improving the clinical outcome
of patients.
About the author
Xu Weihua
- Ph.
D.
, chief physician, master supervisor, deputy director of the Department of Gastroenterology, Second Hospital of Shandong University - Vice Chairman of the 5th Hepatology Branch of Shandong Medical Association
- Member of the first committee of the Gastroenterologist Branch of Shandong Medical Association
- Vice Chairman of the Second Session of the Clinical Cell Biotherapy Professional Committee of Shandong Medical Association
- Member of the Stem Cell Engineering Group of the Medical Engineering Branch of the Chinese Medical Association
- Vice Chairman of the Hepatology Professional Committee of Shandong Society of Integrative Medicine
- Director of the first alliance of China Digestive Psychosomatic Alliance
- Deputy head of the multidisciplinary diagnostic group of Shandong Diagnostic Society
- Deputy head of Helicobacter pylori group of Gastroenterology Branch of Shandong Medical Association
- He was awarded the third class merit of the Shandong Provincial Government in resisting "SARS"
- Won the title of National First-line Medical Personnel Anti-epidemic Pioneer
- Won the most beautiful family in the country
References:
[1] SATSANGI J,et al.
Gut,2006,55(6):749-753.
[2] Chen Junyin, et al.
Zhejiang Practical Medicine,2022,27(01):28-32+51.
[3] FEAGAN BG,et al.
N Engl J Med, 2013, 369(8): 699-710.
[4] Kopylov U，et al.
Inflamm Bowel Dis,2017,23(3):404-408.
[5] Shelton E，et al.
Inflamm Bowel Dis,2015,21(12):2879-2885.
[6] Baumgart DC,et al.
Aliment Pharmacol Ther,2016,43(10):1090-1102.
[7] Solberg IC,et al.
Scand J Gastroenerol.
2009,44:431-40.
[8] Clinical Gastroenterology and Hepatology 2015,13:635–642.
[9] FEUERSTEIN JD,et al.
Gastroenterology,2020,158(5):1450-1461.
[10] Li Huibo, et al.
China Journal of New Drugs,2021,30(20):1841-1845.
[11] JAIRATH V,et al.
Expert Rev Gastroenterol Hepatol,2021,15(6):711-722.
[12] NOVAK G,et al.
Expert Opin Drug Saf,2017,16(4):501-507.
[13] SHENG YN,et al.
Value Heal,2020,23:5534.
Disclaimer: This content is intended only for healthcare professionals in China and is intended to provide scientific information to healthcare professionals for personal learning and reference
.
If you are not a healthcare professional, do not participate or spread
.
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