Optimal Management of Acute Severe Ulcerative Colitis (ASUC): Challenges and Solutions

Holvoet, Tom; Lobatón, Triana; Hindryckx, Pieter

doi:10.2147/ceg.s197719

Cited by 28 publications

(16 citation statements)

References 74 publications

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“…Acute severe ulcerative colitis (ASUC), refractory to intravenous corticosteroids (CS), is a challenging condition to treat, and colectomy rates remain high regardless of the efficacy of salvage therapies such as cyclosporine and infliximab [ 37 , 38 ]. A substantial portion of patients do not respond to infliximab, possibly due to low drug exposure as a result of increased disease inflammatory burden and high drug clearance and drug fecal loss [ 39 , 40 , 41 , 42 ].…”

Section: Tdm and Colectomy Rates In Ucmentioning

confidence: 99%

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Nones

Fleshner

Queiroz

et al. 2021

JCM

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Despite significant development in the pharmacological treatment of inflammatory bowel diseases (IBD) along with the evolution of therapeutic targets and treatment strategies, a significant subset of patients still requires surgery during the course of the disease. As IBD patients are frequently exposed to biologics at the time of abdominal and perianal surgery, it is crucial to identify any potential impact of biological agents in the perioperative period. Even though detectable serum concentrations of biologics do not seem to increase postoperative complications after abdominal procedures in IBD, there is increasing evidence on the role of therapeutic drug monitoring (TDM) in the perioperative setting. This review aims to provide a comprehensive summary of published studies reporting the association of drug concentrations and postoperative outcomes, postoperative recurrence (POR) after an ileocolonic resection for Crohn’s disease (CD), colectomy rates in ulcerative colitis (UC), and perianal fistulizing CD outcomes in patients treated with biologics. Current data suggest that serum concentrations of biologics are not associated with an increased risk in postoperative complications following abdominal procedures in IBD. Moreover, higher concentrations of anti-TNF agents are associated with a reduction in colectomy rates in UC. Finally, higher serum drug concentrations are associated with reduced rates of POR after ileocolonic resections and increased rates of perianal fistula healing in CD. TDM is being increasingly used to guide clinical decision making with favorable outcomes in many clinical scenarios. However, given the lack of high quality data deriving mostly from retrospective studies, the evidence supporting the systematic application of TDM in the perioperative setting is still inconclusive.

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Section: Tdm and Colectomy Rates In Ucmentioning

confidence: 99%

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Nones

Fleshner

Queiroz

et al. 2021

JCM

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“…Blocking the JAK signaling pathway has proven successful in other immune-mediated disorders and several oral JAK inhibitors have now received regulatory approval for the treatment of rheumatoid arthritis, psoriasis and UC in adults (19). The induction dose is 10 mg twice daily for at least 8 weeks and may be reduced to 5 mg twice daily for maintenance therapy (19)(20)(21)(22). Data about tofacitinib in IBD are still limited and mainly in adult patients.…”

Section: Discussionmentioning

confidence: 99%

Tofacitinib to Treat Severe Acute Refractory Colitis in a Teenager: Case Report and Review of the Literature

2022

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Objectives: Acute severe colitis (ASC) may occur within 3 months of ulcerative colitis diagnosis in 9%–15% of children and the rate of colectomy is up to 40%–50% within 5 years after an ASC. The aim of this publication is to present recent and relevant data on the success of medical treatment with tofacitinib in ASC. Methods: We report a challenging case of a teenage boy with ASC at diagnosis and conduct a discussion after a review of the literature regarding the use of tofacitinib in inflammatory bowel disease, especially in pediatric patients and in ASC. Results: The patient was hospitalized for 10 weeks and was refractory to conventional therapies: intravenous corticosteroids, infliximab, methotrexate, and vedolizumab. He received 7 blood transfusions and also presented with a severe malnutrition requiring a total parenteral nutrition. Tofacitinib was considered as a medical last resort before colectomy and was started at week 8. Thirteen days after starting tofacitinib, he was asymptomatic and was discharged on tofacitinib as sole treatment. By week 9 of tofacitinib, a colonoscopy showed both endoscopic and histological remission. He has remained in clinical remission at 6-month follow-up. Conclusions: Tofacitinib may be an alternative medical treatment to avoid colectomy in ASC. It is a small molecule with a rapid onset and few severe adverse events. It has been used for ASC in adult patients, allowing to avoid colectomy in more than 60%. To our knowledge, this is one of the few pediatric patients with refractory ASC at initial diagnosis who responded to tofacitinib.

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“…Despite the introduction of salvage therapies such as cyclosporine and infliximab, management of acute severe UC remains challenging and colectomy is still required in a subset of refractory patients ( 72 , 73 ). Failure to infliximab treatment has been associated with low drug exposure as a consequence of increased inflammatory burden, high drug clearance, and fecal loss ( 74 – 77 ).…”

Section: Therapeutic Drug Monitoring In Special Situationsmentioning

confidence: 99%

Multi-utility of therapeutic drug monitoring in inflammatory bowel diseases

2022

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Inflammatory bowel disease (IBD) treatment targets have progressed over time from clinical response to clinical and endoscopic remission. Several data have shown a positive correlation between serum biologic drug concentrations and favorable therapeutic outcomes. Therapeutic drug monitoring (TDM) has evolved as an important approach for optimizing the use of immunobiologics, especially antitumor necrosis factor therapy, in patients with IBD. The use of TDM is supported by medical societies and IBD experts in different contexts; however, challenges remain due to knowledge gaps that limit the widespread use of it. The aim of this review is to assess the role of TDM in IBD, focusing on the implementation of this strategy in different scenarios and demonstrating the multi-utility aspects of this approach in clinical practice.

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Optimal Management of Acute Severe Ulcerative Colitis (ASUC): Challenges and Solutions

Cited by 28 publications

References 74 publications

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Tofacitinib to Treat Severe Acute Refractory Colitis in a Teenager: Case Report and Review of the Literature

Multi-utility of therapeutic drug monitoring in inflammatory bowel diseases

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