Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report

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dc.coverageDOI: 10.12998/wjcc.v9.i13.3219
dc.creatorde Vasconcelos Garate, Ana Lorena Sousa
dc.creatorRocha, Thiara Barcelos
dc.creatorAlmeida, Luciana Rocha
dc.creatorQuera, Rodrigo
dc.creatorBarros, Jaqueline Ribeiro
dc.creatorBaima, Julio Pinheiro
dc.creatorSaad-Hossne, Rogerio
dc.creatorSassaki, Ligia Yukie
dc.date2021
dc.date.accessioned2025-11-18T19:41:21Z
dc.date.available2025-11-18T19:41:21Z
dc.description<p>BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level.CASE SUMMARY A 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (&lt; 30 μg/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy.CONCLUSION Infliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients.</p>eng
dc.identifierhttps://investigadores.uandes.cl/en/publications/e0b8b196-d54c-4e88-8a46-2df825eef97f
dc.identifier.urihttps://repositorio.uandes.cl/handle/uandes/51774
dc.languageeng
dc.rightsinfo:eu-repo/semantics/openAccess
dc.sourcevol.9 (2021) date: 2021-05-06 nr.13 p.3219-3226
dc.subjectAcute severe ulcerative colitis
dc.subjectCase report
dc.subjectInflammatory bowel disease
dc.subjectInfliximab
dc.subjectToxic megacolon
dc.subjectUlcerative colitis
dc.subjectSDG 3 - Good Health and Well-being
dc.titleTreatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case reporteng
dc.typeArticleeng
dc.typeArtículospa
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