Open Label Vancomycin in Primary Sclerosing Cholangitis-Inflammatory Bowel Disease: Improved Colonic Disease Activity and Associations With Changes in Host–Microbiome–Metabolomic Signatures - Scorecard - MDSpire
Advertisement
Open Label Vancomycin in Primary Sclerosing Cholangitis-Inflammatory Bowel Disease: Improved Colonic Disease Activity and Associations With Changes in Host–Microbiome–Metabolomic Signatures
Clinical Scorecard: Efficacy of Oral Vancomycin in Patients with Primary Sclerosing Cholangitis-Related Inflammatory Bowel Disease: Enhanced Colonic Disease Activity and Correlations with Host-Microbiome-Metabolomic Changes
Gut microbial alterations, bile acid homeostasis disruption, immune dysregulation including IL-17 responses
Target Population
Adults (≥18 years) with PSC and active pancolonic IBD
Care Setting
Specialist gastroenterology and hepatology centers with capacity for endoscopic surveillance
Key Highlights
Oral vancomycin (125 mg QID for 4 weeks) induced clinical remission in 12 of 15 PSC-IBD patients with active colitis.
Treatment was associated with reduced fecal calprotectin and significant shifts in gut microbiota composition, including decreased Lachnospiraceae and increased Enterobacteriaceae.
Vancomycin modulated host mucosal gene expression, downregulating inflammatory and antimicrobial pathways and upregulating extracellular matrix repair genes.
Guideline-Based Recommendations
Diagnosis
Confirm PSC diagnosis with clinical, biochemical, and imaging criteria.
Assess IBD activity using partial Mayo colitis score and fecal calprotectin.
Exclude infectious causes of diarrhea prior to antibiotic therapy.
Management
Consider oral vancomycin as an induction therapy for active colitis in PSC-IBD patients.
Administer oral vancomycin at 125 mg four times daily for 4 weeks.
Monitor for clinical remission and biochemical markers such as fecal calprotectin.
Monitoring & Follow-up
Perform colonoscopic assessment and collect colonic biopsies at baseline and after treatment.
Monitor fecal calprotectin and clinical symptoms at baseline, 2, 4, and 8 weeks.
Observe for relapse of colitis activity following vancomycin withdrawal.
Risks
Potential relapse of colitis activity after cessation of vancomycin.
Alterations in gut microbiota diversity and composition with unknown long-term effects.
Contraindications include vancomycin intolerance and recent antibiotic or immunomodulator use.
Patient & Prescribing Data
Adults with PSC and mild to moderately active pancolonic IBD without recent antibiotic or immunomodulator changes.
Oral vancomycin effectively induces remission in PSC-IBD colitis, with associated microbiome and metabolomic changes; relapse may occur after treatment withdrawal.
Clinical Best Practices
Screen for and exclude infectious diarrhea before initiating oral vancomycin.
Use oral vancomycin as a short-term induction agent with close monitoring of clinical and biochemical response.
Incorporate multi-omic assessments where available to understand host-microbiome interactions.
Maintain regular colonoscopic surveillance due to increased colorectal cancer risk in PSC-IBD.
Consider liver transplant status and recurrent PSC in treatment planning.
by Mohammed Nabil Quraishi, Jonathan Cheesbrough, Peter Rimmer, Benjamin H Mullish, Naveen Sharma, Elena Efstathiou, Animesh Acharjee, Georgios Gkoutus, Arzoo Patel, Julian R Marchesi, Stephane Camuzeaux, Katie Chappell, Maria A Valdivia-Garcia, James Ferguson, Matthew J Brookes, Martine Walmsley, Amanda E Rossiter, Willem van Schaik, Ross S McInnes, Rachel Cooney, Michael Trauner, Andrew D Beggs, Tariq H Iqbal, Palak J Trivedi
