P524 Systematic review of calcineurin inhibitors (CNI) and vedolizumab (VDZ) combination therapy in acute severe ulcerative colitis (ASUC)
H. Lin*1, W-C. Lim1
1Tan Tock Seng Hospital, Gastroenterology and Hepatology, Singapore, Singapore
Patients with acute severe ulcerative colitis (ASUC) may be refractory to treatment with steroids and anti-tumour necrosis factor agents (anti-TNF). cyclosporine inhibitors (CNI) have been used effectively as a fast-acting bridge to slower-onset immunomodulators in thiopurine-naïve patients; concerns over toxicity limit prolonged use as maintenance. Patients who are azathioprine-exposed or anti-TNF-refractory have limited medical treatment options, often resulting in colectomy. Combination of CNI as induction and slower-acting but potentially safer vedolizumab (VDZ) has recently been used in patients with severe inflammatory bowel disease (IBD). We aim to review the utility in ASUC.
A systematic bibliographic review was conducted on PubMed using the keywords ‘vedolizumab’, ‘calcineurin inhibitors’, ‘inflammatory bowel disease’, ‘severe ulcerative colitis’. Additional studies were identified by manual search of reference lists. 6 articles were identified within the period 2013 to October 2018. Only English language publications and abstracts on use of combination CNI+VDZ in adult ASUC patients were included. One paediatric study1, one case report,2 and one abstract3 (ASUC data not reported) were excluded.
There were 2 prospective observational studies2,4 [
Preliminary studies of combination CNI and VDZ in patients with ASUC appears promising. However, the methodology in these limited studies was heterogenous. Further prospective trials are needed for the confirmation of the utility and efficacy of this treatment strategy in the management of ASUC.
1. Hamel B, Wu M, Hamel EO,
2. Tarabar D, K. El Jurdi, O. Yvellez. Combination therapy of cyclosporine and vedolizumab is effective and safe for severe, steroid-resistant ulcerative colitis patients: a prospective study.
3. Rutka M, Szántó K, Bor R Efficacy of combination therapy with cyclosporin and vedolizumab in inflammatory bowel diseases refractory to anti-TNF agents.
4. Christensen B, Gibson PR, Micic D,
5. Pellet G, Stefanescu C, Carbonnel F,
6. Alana W, Jami K, David R. Novel use of cyclosporine induction therapy as a bridge to vedolizumab in severe ulcerative colitis.
7. Laharie D, Bourreille A, Branche J,