Jefferson Tran, , Katrina Sykes, , Karen Eskue, , Thomas Tran, MD TMC, Denison, TX
Introduction: Dupilumab is a monoclonal antibody which inhibits interleukin-4 and interleukin-13. It was recently approved by the FDA to treat eosinophilic esophagitis. We report the first use of dupilumab to treat refractory eosinophilic colitis.
Case Description/Methods: The patient is a 79-year-old woman who presented with chronic diarrhea averaging 4 loose stools daily. She denied having abdominal pain, nausea, vomiting, fever, chills, or rectal bleeding. She underwent a colonoscopy with colonic biopsies which showed eosinophilic colitis. She was placed on Budesonide which did not help. Cholestyramine was added with no improvement. A trial of Xifaxan for possible IBS-D was initiated with no effects. The patient went into dehydration and severe hypokalemia (K of 3) requiring hospitalization for IVF and KCl replacement. GI PCR, C. difficile and SAR Covid-19 tests were negative for infectious etiologies. Prednisone and Solumedrol were ineffective. The diarrhea worsened to 15-20 loose stools daily, interfering with all her activities. Given her clinical deterioration and failure of multiple treatment modalities, we offered Dupilumab as an off-label use. The patient fully understood that Dupilumab had not been approved by the FDA for eosinophilic colitis and accepted all possible side effects. The first dose of 300 mg was given subcutaneously. Within a day, her diarrhea resolved completely. Dupilumab treatment was given weekly for 6 weeks. A repeat colonoscopy was normal with complete resolution of eosinophilic colitis on pathology. The patient is currently on a maintenance regimen every 2 weeks with no recurrence of diarrhea.
Discussion: Dupilumab has been approved for atopic dermatitis, asthma, nasal polyposis, prurigo nodularis, and eosinophilic esophagitis. By blocking interleukins 4 and 13, Dupilumab inhibits an inflammatory pathway. Eosinophilic colitis is a rare disease in which the colon is infiltrated by eosinophils. Therapeutic options are limited and mostly based on case reports and case series. We report a novel use of dupilumab to successfully treat refractory eosinophilic colitis. Randomized controlled trials are needed to establish the optimal therapeutic approach.
Disclosures:
Jefferson Tran indicated no relevant financial relationships.
Katrina Sykes indicated no relevant financial relationships.
Karen Eskue indicated no relevant financial relationships.
Thomas Tran indicated no relevant financial relationships.
Jefferson Tran, , Katrina Sykes, , Karen Eskue, , Thomas Tran, MD. P3077 - Novel Use of an Interleukin-4 and Interleukin-13 Monoclonal Antibody to Treat Refractory Eosinophilic Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
