P-182 YI E-cigarettes as Salvage Therapy for Medically Refractory Ulcerative Colitis

Abstract

BACKGROUND: Cigarette smoking has been associated with clinical improvement of ulcerative colitis, yet clinical trials of various nicotine preparations have failed to conclusively demonstrate efficacy. E-cigarettes are electronic nicotine vaporizers meant to simulate tobacco smoking with theoretically lower cardiovascular health risks. There are no published studies or cases of the use of e-cigarettes for the treatment of ulcerative colitis. METHODS: We describe the case of a 35 year old man with a one and half year history of pan-ulcerative colitis which began 4 weeks after smoking cessation. He had been refractory to mesalamine, purinethol, corticosteroids (prednisone 40 mg daily) and infliximab which was eventually escalated to 10 mg/kg every 4 weeks (due to undetectable infliximab trough concentrations and no anti-infliximab antibodies). Despite this regimen, he had severe symptoms (total and partial Mayo scores of 11 and 8, respectively) with up to 15 bloody bowel movements daily and severe urgency with incontinence. He was advised to undergo restorative proctocolectomy for medically-refractory disease. RESULTS: In discussion with his gastroenterologist, he initiated e-cigarette use (mean 105 puffs/day, range 45 to 191). Four weeks after starting e-cigarettes, his partial Mayo score decreased from 8 to 2, with complete cessation of rectal bleeding, formed stools and no urgency. Fecal calprotectin decreased from 424 to 25 [micro]g/g. By 8 weeks, he continued to feel well (partial Mayo of 0) and had completely tapered off corticosteroids. At 12 weeks following e-cigarette initiation, infliximab trough concentrationswere greater than 34, and the interval between infusions was therefore increased. CONCLUSIONS: E-cigarette use was associated with steroid-free clinical remission in a patient with medically-refractory ulcerative colitis which began after smoking cessation. It was also associated with improved infliximab pharmacokinetics. Further evaluation of this product for the treatment of ulcerative colitis is warranted. During nursing intake, it is important that nurses "dig deep" into the smoking history of patients with ulcerative colitis to better understand the potential association between smoking, smoking cessation, and symptoms in order to fully understand potential triggers and therapeutic options, such as this novel potential therapy.