Multicenter Study

. 2024 May;59(10):1236-1247.

doi: 10.1111/apt.17936. Epub 2024 Mar 10.

Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD): A matched analysis from the Paediatric PSC Consortium

Amanda Ricciuto¹, Kuan Liu², Wael El-Matary³, Mansi Amin⁴, Achiya Z Amir⁵, Madeleine Aumar⁶, Marcus Auth⁷, Matthew D Di Guglielmo⁸, Eleonora Druve Tavares Fagundes⁹, Alexandre Rodrigues Ferreira¹⁰, Katryn N Furuya¹¹, Nitika Gupta¹², Stephen Guthery¹³, Simon P Horslen¹⁴, Kyle Jensen¹³, Binita M Kamath¹, Nanda Kerkar¹⁵, B G P Koot¹⁶, Trevor J Laborda¹³, Christine K Lee¹⁷, Kathleen M Loomes¹⁸, Cara Mack¹⁹, Mercedes Martinez²⁰, Aldo Montano-Loza²¹, Nadia Ovchinsky²², Alexandra Papadopoulou²³, Emily R Perito²⁴, Pushpa Sathya²⁵, Kathleen B Schwarz²⁶, Uzma Shah²⁷, Eyal Shteyer²⁸, Nisreen Soufi²⁹, James Patrick Stevens³⁰, Amy Taylor³¹, M Elizabeth Tessier³², Pamela Valentino³³, Marek Woynarowski³⁴, Mark Deneau¹⁹; Pediatric PSC Consortium

Affiliations

¹ The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
³ Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Duke University Medical Center, Durham, North Carolina, USA.
⁵ Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel.
⁶ CHU de Lille, Lille, France.
⁷ Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, UK.
⁸ Nemours Children's Health, Wilmington, Delaware, USA.
⁹ Faculty of Medicine of Federal University of Minas Gerais (UFMG), Hospital das Clinicas of UFMG, Belo Horizonte, Brazil.
¹⁰ Hospital das Clinicas of UFMG, Belo Horizonte, Brazil.
¹¹ University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
¹² Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
¹³ Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA.
¹⁴ UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁵ Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA.
¹⁶ Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Boston Children's Hospital, Boston, Massachusetts, USA.
¹⁸ The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁹ Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
²⁰ Columbia University Irving Medical Center, New York-Presbyterian, New York, New York, USA.
²¹ Zeidler Ledcor Centre, University of Alberta, Edmonton, Alberta, Canada.
²² NYU Grossman School of Medicine, New York City, New York, USA.
²³ First Department of Pediatrics, Athens Children's Hospital "AGIA SOFIA", University of Athens, Athens, Greece.
²⁴ University of California San Francisco, San Francisco, California, USA.
²⁵ Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
²⁶ Rady Children's Hospital San Diego, San Diego, California, USA.
²⁷ Henry Ford Health, Detroit, Michigan, USA.
²⁸ Shaare Zedek Medical Center, Jerusalem, Israel.
²⁹ Children's Hospital Los Angeles, Los Angeles, California, USA.
³⁰ Emory University School of Medicine, Atlanta, Georgia, USA.
³¹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
³² Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
³³ University of Washington School of Medicine, Seattle Children's, Seattle, Washington, USA.
³⁴ Jan Kochanowski University, Kielce, Poland.

PMID: 38462727
DOI: 10.1111/apt.17936

Multicenter Study

Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD): A matched analysis from the Paediatric PSC Consortium

Amanda Ricciuto et al. Aliment Pharmacol Ther. 2024 May.

. 2024 May;59(10):1236-1247.

doi: 10.1111/apt.17936. Epub 2024 Mar 10.

Authors

Affiliations

¹ The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
³ Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Duke University Medical Center, Durham, North Carolina, USA.
⁵ Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel.
⁶ CHU de Lille, Lille, France.
⁷ Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, UK.
⁸ Nemours Children's Health, Wilmington, Delaware, USA.
⁹ Faculty of Medicine of Federal University of Minas Gerais (UFMG), Hospital das Clinicas of UFMG, Belo Horizonte, Brazil.
¹⁰ Hospital das Clinicas of UFMG, Belo Horizonte, Brazil.
¹¹ University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
¹² Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
¹³ Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA.
¹⁴ UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁵ Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA.
¹⁶ Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Boston Children's Hospital, Boston, Massachusetts, USA.
¹⁸ The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁹ Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
²⁰ Columbia University Irving Medical Center, New York-Presbyterian, New York, New York, USA.
²¹ Zeidler Ledcor Centre, University of Alberta, Edmonton, Alberta, Canada.
²² NYU Grossman School of Medicine, New York City, New York, USA.
²³ First Department of Pediatrics, Athens Children's Hospital "AGIA SOFIA", University of Athens, Athens, Greece.
²⁴ University of California San Francisco, San Francisco, California, USA.
²⁵ Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
²⁶ Rady Children's Hospital San Diego, San Diego, California, USA.
²⁷ Henry Ford Health, Detroit, Michigan, USA.
²⁸ Shaare Zedek Medical Center, Jerusalem, Israel.
²⁹ Children's Hospital Los Angeles, Los Angeles, California, USA.
³⁰ Emory University School of Medicine, Atlanta, Georgia, USA.
³¹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
³² Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
³³ University of Washington School of Medicine, Seattle Children's, Seattle, Washington, USA.
³⁴ Jan Kochanowski University, Kielce, Poland.

PMID: 38462727
DOI: 10.1111/apt.17936

Abstract

Background: Data on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited.

Aims: Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity.

Methods: In this retrospective multi-centre cohort study, we matched vancomycin-treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE.

Results: 113 PSC-IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin-treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97-6.31; adjusted OR [aOR] 5.24, 95% CI 2.68-10.22). Benefit was maintained in sensitivity analyses restricted to non-transplanted patients and those with baseline moderate-severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002-7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01).

Conclusion: Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing.

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Comment in

Editorial: Is it time to include oral vancomycin in therapeutic guidelines for primary sclerosing cholangitis-associated inflammatory bowel disease?
Shah A, Holtmann G. Shah A, et al. Aliment Pharmacol Ther. 2024 May;59(10):1290-1291. doi: 10.1111/apt.17990. Aliment Pharmacol Ther. 2024. PMID: 38652768 No abstract available.

References

REFERENCES

1. Karlsen TH, Folseraas T, Thorburn D, Vesterhus M. Primary sclerosing cholangitis—a comprehensive review. J Hepatol. 2017;67:1298–1323.
1. Ricciuto A, Kamath BM, Griffiths AM. The IBD and PSC phenotypes of PSC‐IBD. Curr Gastroenterol Rep. 2018;20:16.
1. Mileti E, Rosenthal P, Peters MG. Validation and modification of simplified diagnostic criteria for autoimmune hepatitis in children. Clin Gastroenterol Hepatol. 2012;10:417–421.e2.
1. Little R, Wine E, Kamath BM, Griffiths AM, Ricciuto A. Gut microbiome in primary sclerosing cholangitis: a review. World J Gastroenterol. 2020;26:2768–2780.
1. Kummen M, Holm K, Anmarkrud JA, Nygård S, Vesterhus M, Høivik ML, et al. The gut microbial profile in patients with primary sclerosing cholangitis is distinct from patients with ulcerative colitis without biliary disease and healthy controls. Gut. 2016;66:611–619.

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Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD): A matched analysis from the Paediatric PSC Consortium

Affiliations

Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD): A matched analysis from the Paediatric PSC Consortium

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous