A pediatric case of moderate active ulcerative colitis successfully treated with vedolizumab in Japan
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CASE REPORT
A pediatric case of moderate active ulcerative colitis successfully treated with vedolizumab in Japan Aiko Ikeuchi1 · Toshihiko Kakiuchi1 · Arisa Ibi1 · Muneaki Matsuo1 Received: 12 June 2020 / Accepted: 29 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Corticosteroids and biologics are used to treat moderate-to-severe active pediatric ulcerative colitis (UC); however, it is often difficult to continue administration because of systemic side reactions. Vedolizumab is considered to have few adverse effects due to its mechanism of action and it is expected to be used in children, but the long-term administration of vedolizumab to Japanese pediatric patients with UC has not been reported. We report a case of pediatric moderate active UC with anti-tumor necrosis factor-failure that was successfully treated with vedolizumab in Japan. Keywords Vedolizumab · Ulcerative colitis · Child · Anti-TNF-failure
Introduction
Case presentation
Vedolizumab (VDZ) is a monoclonal antibody to α 4β7 integrin, and inhibits the interaction between mucosal vascular addressing cell adhesion molecule-1 (MAdCAM-1) and lymphocytes. MAdCAM-1 is selectively expressed on gastrointestinal submucosa [1], and therefore, VDZ is considered a drug with few systemic side effects [2]. Outside Japan, it has been used as treatment for inflammatory bowel disease (IBD) since 2014. It is used for both the introduction and maintenance of remission, and it has been reported to have good therapeutic results [3–5]. In Japan, VDZ was approved in 2018 and has been used to treat a large number of adult IBD patients [6]. However, there have been few instances of pediatric use, especially in Japan. To the best of our knowledge, there are no reports of Japanese children treated with VDZ in the long term. We report a case of pediatric moderate active ulcerative colitis (UC) in Japan, which was successfully treated with VDZ.
An 11-year-old girl had visited a clinic with diarrhea lasting 2 weeks and bloody stools lasting one week. Although she was initially treated with oral antibiotics, she was introduced to an affiliated hospital and underwent intravenous antibiotic therapy because of lack of improvement in clinical symptoms. Her condition still did not improve, and she was referred to our hospital. Her height was 140 cm [− 1.1 standard deviation (SD)] and body weight was 30 kg (− 1.2 SD). Her vital signs were normal, body temperature was 37.3 °C, heart rate was 83 beats/min, and blood pressure was 98/52 mmHg. Physical examination revealed no anemia, and her abdomen was soft and flat without tenderness. Table 1 shows the blood test results. The patient’s white blood cell count was 10,900/µL (normal range 3300–8600/ µL) and hemoglobin level was 12.5 g/dL (normal range 11.6–14.8 g/dL). Her laboratory findings were as follows: total protein level was 6.9 g/dL (normal range 6.6–8.1 g/ dL), serum albumin was 3.9 g/dL (normal range 4.1–5.1 g/ dL), C-reactive protein was 0.06 mg/dL (normal range 0.00–0.14 mg/dL), serum amyloid A prote
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