The Use of Vedolizumab in Patients with Concomitant Cirrhosis and Crohn's Disease.

Nikhil Kapila,Jamak Modaresi Esfeh,Bo Shen,Gianina Flocco

doi:10.7759/cureus.3080

Nikhil Kapila, Jamak Modaresi Esfeh + Show 2 more

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https://doi.org/10.7759/cureus.3080

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Journal: Cureus	Publication Date: Jul 31, 2018
Citations: 2	License type: cc-by

Affiliation: Cleveland Clinic, Cleveland Clinic Florida

Abstract

Vedolizumab is a humanized monoclonal α4β7 integrin antibody used in patients with Crohn’s disease (CD) and ulcerative colitis (UC). Limited data are available on the use of vedolizumab in patients with concurrent cirrhosis and inflammatory bowel disease (IBD). Patients with cirrhosis are unique, as they have a predilection for developing opportunistic infections and malignancies. Additionally, it is not known if vedolizumab alters the natural course of cirrhosis. We report our experience in three patients with concomitant CD and cirrhosis, who were treated with vedolizumab. In our limited cohort, all the three patients tolerated vedolizumab well. None of them experienced significant infectious complications, nor did any have decompensated cirrhosis. Our limited series suggest that vedolizumab is well tolerated in patients with compensated cirrhosis.

Highlights

We report our experience in three patients with concomitant Crohn’s disease (CD) and cirrhosis, who were treated with vedolizumab
Vedolizumab is a humanized monoclonal α4β7 integrin antibody that is approved for use in the management of patients with moderate to severe Crohn’s disease (CD) and ulcerative colitis (UC)
Neither the landmark studies that described the efficacy of vedolizumab nor the recent studies that describe their long-term safety have reviewed the use of vedolizumab in patients with concomitant inflammatory bowel disease (IBD) and cirrhosis [2,3]

Summary

Introduction

Vedolizumab is a humanized monoclonal α4β7 integrin antibody that is approved for use in the management of patients with moderate to severe Crohn’s disease (CD) and ulcerative colitis (UC). Cirrhosis was confirmed by liver biopsy and the patient achieved a sustained virologic response after completing therapy with interferon and ribavirin He has a five-year history of CD involving the small bowel, had undergone a prior resection of the distal ileum, and has previously been treated with budesonide and 6-mercaptopurine (6-MP). Thirty-two months post treatment, the patient continues on vedolizumab 300 mg every eight weeks and his CD is in clinical remission He has not had any episodes of hepatic decompensation and his posttreatment MELD-Na score is seven and CTP A6. The last case is of a 65-year-old male with an 11-year history of small bowel CD and cryptogenic cirrhosis He was initially treated with steroids, infliximab, and azathioprine; due to non-response, How to cite this article Kapila N, Flocco G, Shen B, et al (July 31, 2018) The Use of Vedolizumab in Patients with Concomitant Cirrhosis and Crohn’s Disease. After initiation of vedolizumab 300 mg every eight weeks for five months, the patient’s MELD-Na was 11 and CTP A6 with no decompensated cirrhosis or significant infection

Discussion

Conclusions

Disclosures