Ulcerative Colitis Case Study: Targeted Therapy and Vedolizumab

Vocabulary flashcards covering the clinical management, drug profiles, and monitoring requirements for Ulcerative Colitis based on Reema's case study.

Anti-TNF Therapy (Adalimumab, Golimumab, Infliximab)

Therapies that target $TNF-a$ but are not ideal for patients with heart failure or high infection risk, as they can worsen heart failure and increase the risk of infections like pneumonia.

Upadacitinib

A $JAK1$ inhibitor that targets raised $JAK1$ levels but carries risks of serious infection and thromboembolism; it requires caution in older patients and those with heart failure or diabetes.

Vedolizumab

An integrin receptor antagonist that blocks $a4b7$ integrin using a gut-selective mechanism, resulting in lower systemic immunosuppression and a safer profile for patients with heart failure, lung disease, and diabetes.

Arthralgia

A side effect of Vedolizumab characterized by joint pain without inflammation.

Vedolizumab Induction Regimen

The initial dosing schedule consisting of $300\,\text{mg}$ IV administered at weeks $0$, $2$, and $6$.

Vedolizumab Maintenance Regimen

The long-term dosing of $300\,\text{mg}$ IV every $8$ weeks, which can be increased to every $4$ weeks if there is an inadequate response.

Pre-treatment Monitoring

Mandatory screenings before starting targeted therapy, including infection screening for TB and hepatitis, and baseline blood tests for FBC, LFTs, and CRP.

Ongoing Treatment Monitoring

Regular checks during therapy including CRP and faecal calprotectin to monitor response, alongside FBC, LFTs, and monitoring for infections.

Gut-selective mechanism

A characteristic of Vedolizumab that limits immunosuppression primarily to the gastrointestinal tract, making it safer for comorbid patients compared to systemic immunosuppressants.

Clinical Exacerbation Criteria (Reema's Case)

A status defined by $10$ exacerbations in the last year requiring corticosteroids and hospitalisation, with symptoms like Diarrhoea approx. $8$-$9$ times a day and excruciating abdominal pain.