I am wondering if anyone has a suggestion for ipilimumab (10 mg/kg dose) induced ileitis/colitis that has been refractory to both oral and IV steroids as well as three doses of infliximab. We have been treating her since May on steroids for this issue. We wanted to give vedolizumab as there are some reports of this being used in these cases, but her insurance company will not pay for it (despite a peer to peer review and referenced articles). We have consulted the GI team, but they do not have any other suggestions. We are planning to give another dose of infliximab, but if anyone has a different suggestion, I would welcome it!
Regarding your adjuvant patient who is experiencing ongoing colitis despite 3 doses of infliximab,vedolizumab would have been a good next step consideration, unfortunately, this is not an option. Just a thought, could the patient be treated on a routine “colitis” regimen with maintenance dosing rather than episodic dosing until sx are under long term control. Thoughts?
Hi Virginia, Agree the vedolizumab would have been ideal and we’ve done this in several patients. Have you tried to appeal to the company via a patient assistance program? We were able to get this paid for via this route for one patient. Additionally we had one patient that ended up having some really uncommon sort of pathogen and we were able treat with antibiotics and she had significant improvement and was able to wean off the steroids.
Thank you Kathleen and Lisa for your feedback.
Kathleen, we are going to start maintenance dosing with infliximab which is a great suggestion. Lisa, I had not thought about approaching the company for assistance. I will look into that. We have sent stool for C diff, shigella, salmonella and camplyobacter all of which were negative. Interestingly, she is now being treated for serratia bacteremia with cipro so it will interesting to see if that helps.