VEDOLIZUMAB FOR REFRACTORY MICROSCOPIC COLITIS: A CASE SERIES

Microscopic colitis (MC) is a chronic inflammatory disease of the colon that causes non-bloody, watery diarrhea occurs up to 15 times daily in presence normal-appearing mucosa colon. There are two main subtypes MC based on histopathologic features, collagenous (CC) and lymphocytic (LC)1. Treatment each subtype similar should be determined by severity symptoms. Some patients suffer severe symptoms despite maximum dosage budesonide, these cases biologic therapies considered. Vedolizumab, monoclonal antibody targets ?4?7-integrin, gut-specific with an exceptional safety profile. Here, we report our experience vedolizumab for severe, refractory MC. Eleven presenting University Kentucky microscopic budesonide Imodium therapy were treated vedolizumab. Vedolizumab was given at standard induction dosing (300mg IV week 0, 2 6, then every 8 weeks). Of eleven included this study, seven reported subjective symptomatic improvement monotherapy, four attaining less than 3 stools per day. remaining patients, one continues do well combination while another developed rash after treatment stopped. The third patient transitioned from adalimumab now controlled symptomatically final has not reached remission her disease. Interestingly, who displayed 5/7 also showed albumin levels. use increasingly recognized as conceivable remission. Our case series corroborates findings, majority overall improved quality life. binds ?4?7-integrin prevent adhesion its ligand, MAdCAM-1, which downstream prevention T-cell adhesion. Although exact pathophysiology remains largely unidentified, it been postulated exposure luminal antigen may trigger cascade, leading activation CD8 T suppressor cells attack cause damage enterocytes2. This hypothesis supported vedolizumab’s mechanism action proposed efficacy Due low volume studies, data supporting limited, further studies needed elucidate potential first-line therapy. However, experience, recommend considering suffering