The use of infliximab in treatment refractory collagenous colitis: A case report

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Hodges, Jaci
Darden, Kimberly
Hale, LaDonna S.

Hodges, Jaci. 2019. The use of infliximab in treatment refractory collagenous colitis: A case report -- In Proceedings: 15th Annual Symposium on Graduate Research and Scholarly Projects. Wichita, KS: Wichita State University


INTRODUCTION: Microscopic colitis (MC) is a common cause of non-infectious watery diarrhea in adults but the etiology is unknown. Research regarding management of MC is limited making current guidelines only weakly evidence-based. Several classes of medications have been studied and used to treat MC, yet only one, corticosteroids, is supported by randomized controlled trials. Due to the variable response rates of treatment options and high percentage of refractory cases, providers have trialed biological immunomodulators for treatment of MC, the same medications used to treat rheumatoid arthritis, psoriasis, and ulcerative colitis. This report describes a case of collagenous MC refractory to common treatments that improved with the use of a biological immunomodulator, specifically the tumor necrosis factor (TNF)-α antagonist, infliximab (Remicade®). PURPOSE: This report presents a case of refractory MC successfully treated by infliximab and thus illustrates the need for further research into biological immunomodulators for treatment of MC. CASE DESCRIPTION: A 66-year-old Caucasian male, previously diagnosed with MC, presented with severe diarrhea and significant weight loss despite trials of several conventional medications including: glucocorticoids (budesonide and prednisone), bismuth subsalicylate, antidiarrheals (loperamide), mesalamine and cholestyramine. Infliximab successfully terminated the diarrhea. DISCUSSION: Due to small sample sizes and low quality research, other than corticosteroids, recent systematic reviews have failed to provide strong evidence supporting the currently recommended MC treatment options. Recently, published case reports and case series are starting to lend support to biological immunomodulators; however, similar to other MC treatment options, larger, randomized controlled trials are still needed. CONCLUSION: TNF-α agents, such as infliximab may be a valid treatment option for patients with refractory cases of MC.

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Presented to the 15th Annual Symposium on Graduate Research and Scholarly Projects (GRASP) held at the Rhatigan Student Center, Wichita State University, April 26, 2019.
Research completed in the Department of Physician Assistant, College of Health Professions