Wael Tuqan, MD1, Faisal Siddiqi, DO2, Arnab Ray, MD, FACG2; 1Ochsner Medical Center, Metairie, LA; 2Ochsner Clinic Foundation, New Orleans, LA
Introduction: >Monoclonal antibodies are employed in the treatment of malignancies and auto-immune disorders >Case reports demonstrate colitis in patients prescribed monoclonal antibody therapies >Ocrelizumab is an anti-CD20 monoclonal antibody approved in 2017 for treatment of multiple sclerosis >Herein, we present the first documented case of Ocrelizumab-induced colitis
Methods: >61-year-old female with history of multiple sclerosis presents to the gastroenterology clinic due to recurrent diarrhea. >She was started on Ocrelizumab (dosed every 6 months) prior to the development of diarrhea >Colonoscopy including random colonic biopsies 5 months after initiation of Ocrelizumab were unremarkable. >Diarrhea transiently worsened following each infusion. >Flexible sigmoidoscopy 2 months after third dose of Ocrelizumab was notable for moderate inflammation and histology consistent with drug-induced colitis. (figure 1) >She was hospitalized due to worsening diarrhea and dehydration. >She was started on budesonide and mesalamine. >Three-month follow-up flexible sigmoidoscopy demonstrated improving colitis. (figure 2) Discussion: >Ocrelizumab is a humanized anti-CD20 monoclonal antibody approved for multiple sclerosis >There are no known case reports of Ocrelizumab-induced colitis. >Drug-induced colitis has been reported with the use of Rituximab, a chimeric anti-CD20 monoclonal antibody. >Colitis is postulated to stem from disruption in equilibrium of the gastrointestinal mucosa between proinflammatory and anti-inflammatory stimuli from the innate immune system. Inactivation of B-lymphocytes via monoclonal antibodies may lead to the activation of cytotoxic T cells and subsequent colitis. >Course of drug induced colitis is typically mild, and supportive management and withdrawal of offending agent usually reverses colitis. Steroids has been used with success for more severe inflammation.
Figure 1. Flexible sigmoidoscopy 5 months after first dose of Ocrelizumab showing diffuse moderate inflammation in recto-sigmoid and descending colon.
Figure 2. Follow-up flexible sigmoidoscopy 3 months after withdrawal of Ocrelizumab and treatment with mesalamine and budesonide. Scattered non-bleeding aphthae in the rectum and sigmoid colon.
Disclosures: Wael Tuqan indicated no relevant financial relationships. Faisal Siddiqi indicated no relevant financial relationships. Arnab Ray indicated no relevant financial relationships.