Two Strikes but Not Out: Deep Remission of Ulcerative Colitis with Ustekinumab After Primary Non-response to Infliximab and Vedolizumab

Excerpt

A 27-year-old female with a history of hypertension was diagnosed with pan-ulcerative colitis (UC) after experiencing several weeks of diarrhea, hematochezia, and abdominal cramping. She was initially treated with 5-ASA and azathioprine, both of which did not control her symptoms. She was started on infliximab at 5 mg/kg every 8 weeks but had persistent moderate proctitis as assessed by colonoscopy after several months of therapy. Her dose was gradually increased to 7.5 mg/kg, and then, 10 mg/kg every 6 weeks after follow-up colonoscopy demonstrated moderate erythema and friability from the ascending colon to the cecum. A repeat colonoscopy after 6 months at this dose revealed ongoing moderate inflammation in the cecum. At this time, her serum laboratory markers were normal including C-reactive protein (1.1 mg/L), sedimentation rate (17 mm/h), albumin (4.3 g/dL), and platelet count (245 K/µL). Since her infliximab levels were therapeutic and infliximab antibodies were not present, she was transitioned three months later to vedolizumab 300 mg every 8 weeks without a trial of methotrexate due to patient preference. …