Oral Vancomycin study

[Pangolin]

Anyone tried this? Due to the lack of absorption, this seems like it might be a safe option. Check out the graphs in the study--impressive reduction of pain, blood, and anemia.

https://academic.oup.com/crohnscolitis360/article/1/2/otz015/5532749
Objective
To study the efficacy of oral vancomycin (POV) treatment in pediatric inflammatory bowel disease (IBD).

Methods
We conducted retrospective and prospective chart reviews, identifying patients using the Division’s Inflammatory Bowel Disease (IBD) registry, ICD-9 and ICD-10 codes for IBD, and recall of patients receiving POV. Patients aged 2–21 years with active IBD at initiation of POV were included unless they had Clostridium difficileinfection or primary sclerosing cholangitis (PSC). Pre- and posttreatment analysis included a Physician Global Assessment (PGA), pediatric ulcerative colitis (UC) activity index (PUCAI), and an abbreviated pediatric Crohn’s disease (CD) activity index (PCDAI). The Wilcoxon Signed Ranks test, determined if pre- and post-POV rankings of symptom severity differed. Mann–Whitney U tests assessed improvement in presenting symptoms.

Results
Nineteen patients met inclusion criteria (12 CD and 7 UC). POV improved the PGA score in 16 of 19 patients (P < 0.001). Mean PGA score pretreatment was 3 ± 0.471; posttreatment mean of 1.58 ± 0.769. Abdominal pain (P < 0.001), diarrhea (P < 0.002), anemia (P < 0.002), and blood in stool (P < 0.001) showed significant improvement. PUCAI and PCDAI scores, pretreatment means of 50 ± 17 and 33 ± 9, respectively, also improved with mean score reduction of 23 in CD and 38 in UC patients after POV initiation (P-value < 0.0001). This improvement was noted for both IBD subtypes.

Conclusions
POV may be an effective adjuvant treatment for pediatric IBD. Its effectiveness is likely due to a combination of its anti-tumor necrosis factor alpha-α activity and its influence on the gut microbiome. Further controlled studies of POV in IBD are warranted to determine the most efficacious use of POV in pediatric IBD.

 

[GirlwiththeCurl]

I'm interested to see this pop up. I've seen at least one article saying it was effective in maintaining remission in UC ped patients, I believe, but they may have also had PSC (article was posted on a liver group I follow). I've asked my daughter's doc about OV a couple of times and she will only use it if everything else fails, and only for her liver. But maybe if it shows success in just IBD it'll be a more attainable option.

 

[my little penguin]

Look at Table 2 of the study
It shows the vancomycin was an adjunct med
A few were switched to a systemic steriod plus vancomycin and other drugs
One biologic plus vancomycin

So as you said @GirlwiththeCurl
The kids were mostly out of options

This study was not vancomycin by itself

Some were vancomycin only but not many

Other issue to consider
Long term abx means you can’t use that abx drug later when it might be needed

 

[crohnsinct]

O tried it this past summer during one of her hospitalizations and continued at home after. Even with Entyvio and steroids it didn't work for her. She was switched to the triple antibiotic therapy for three weeks (still on Entyvio andvsteroids) and that didn't work either.

When the GI's presented it they gave us all the studies. No overwhelming evidence it is an effective therapy. It has about a 50% or less of working. Works better in UC than Crohns and therefore better in colonic Crohns than small bowel. It is NOT a long term therapy. Used short term to induce remission. Often times it doesn't work while using it but it does kick in later. It hasn't for O. She was declared a fail on it.

Also with the triple or quadruple antibiotic therapy every study uses different combos and amounts.

It is a last resort option. It was presented to us to try before total colectomy.

Our other Hail Mary was the double dose of Entyvio which seems to maybe be doing it.

 

[GirlwiththeCurl]

Here's the article I saw, but the study is specific to PSC-UC patients.
https://doi.org/10.1093/ibd/izz027

 

[Pangolin]

Look at Table 2 of the study
It shows the vancomycin was an adjunct med
A few were switched to a systemic steriod plus vancomycin and other drugs
One biologic plus vancomycin

So as you said @GirlwiththeCurl
The kids were mostly out of options

This study was not vancomycin by itself

Some were vancomycin only but not many

Other issue to consider
Long term abx means you can’t use that abx drug later when it might be needed

They were all on other medications, but most kids in the study did not have additional medications added at the time of the vancomycin that could have explained the results. The improvements in pain, diarrhea, anemia, and blood in stool are large enough that they can't be explained by the other changes. The study authors tried to isolate changes around the time that the vancomycin was added, and it does look like vancomycin was effective in these patients.

 

[my little penguin]

I get what your saying but
A+B= C
Is not the same as A all by itself
In my kids case methotrexate helps as an adjunct medicine
When methotrexate is combined with a biologic (Stelara in my kids case ) he is much better off than when he is on a biologic by itself

That said methotrexate by itself does nothing for my kiddo

My point was that most of these kids in the study were on multiple meds which weren’t enough
They were out of options
So they added vancomycin to the large mix of meds
Which worked in combination

Vancomycin by itself as single drug was not studied
That would need to be a separate study to prove
Vancomycin as a mono therapy can be an effective therapy

The title of the article was Vancomycin as an adjunct therapy.

 

[crohnsinct]

Even the authors say as much in their conclusion.

POV may be an effective adjuvant treatment for pediatric IBD. Its effectiveness is likely due to a combination of its anti-tumor necrosis factor alpha-α activity and its influence on the gut microbiome. Further controlled studies of POV in IBD are warranted to determine the most efficacious use of POV in pediatric IBD.

It was a very small study and was a prospective study using chart review and they therefore say, further controlled studies are warranted. One other caveat to interpreting this study is that improvement is very heavily referred to as symptom improvement and no scopes were conducted. Also, majority of the subjects were rated as moderate disease activity pre vancomycin. Also, not a long term therapy.

Our team cited the affect of vancomycin on the gut micro biome as the overwhelming reason why we should try it for O.

Not knocking the use of vancomycin. I obviously found it interesting enough to try it for my own daughter. Just saying that while research papers are interesting a lot more has to go into interpreting them. I am just excited that the IBD researchers are looking at many different strategies these days so our kids will have options.

 

[Maya142]

My kiddo used Vancomycin several times for C.Diff. More than once, the C.Diff then led to a Crohn's flare, which the Vancomycin did not help (we continued Vancomycin for a while, thinking she still had C.Diff). We eventually had to go to steroids to control the Crohn's.

My guess is that it helps certain patients in combination with other meds. But it is an interesting study!