To the editor: The GEMINI trials demonstrated the benefit of vedolizumab on clinical outcomes in moderate-to-severe ulcerative colitis and Crohn’s disease 1,2. Subsequently, the VARSITY trial went further to show endoscopic, radiologic and histologic healing in active Crohn’s disease with vedolizumab 3. Unfortunately, immune-checkpoint inhibitor (ICI) colitis has become an increasingly prevalent disease requiring similar therapeutic options to inflammatory bowel disease 4. Gastrointestinal tract immune-related adverse events (ir-AEs) are the most common adverse event following treatment with an ICI, such as the anti-PD1 nivolumab and anti-CTLA4 ipilimumab, with diarrhea occurring in 20—22 for anti-PD1 and 22—44 for combination therapy 5,6; overall severity ranges from mild to perforation and death 7. Although the severity and quantity of ir-AEs correlate with treatment effectiveness, guidelines suggest holding the ICI during treatment for moderate to severe colitis, risking malignancy recurrence. Current guidelines for ICI-colitis recommend first-line glucocorticoids, although 33—66 of patients do not respond and require escalation to immunotherapy with infliximab 8. Should infliximab fail to resolve the ICI-colitis, alternative treatment options are required, but have not been adequately studied in clinical trials. We present a case of a patient that was steroid-refractory and unresponsive to infliximab, but had resolution of his ICI-colitis following treatment with vedolizumab (Fig. 1).
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