Abstract

PUPLA-BARTOLL, A; BELLES-MEDALL, MD; MUNOZ-VICENTE, M  and  FERRANDO-PIQUERES, R. Plasma monitoring after the systemic absorption of rectal tacrolimus in ulcerative colitis refractory to the habitual treatment. Rev. OFIL·ILAPHAR [online]. 2023, vol.33, n.3, pp.314-316.  Epub Feb 28, 2024. ISSN 1699-714X.  https://dx.doi.org/10.4321/s1699-714x2023000300016.

Ulcerative colitis (UC) is a chronic and idiopathic disease caused by an inappropriate inflammatory response that causes lesions with a continuous distribution in the colonic mucosa. As a first option, 5-aminosalicylic acid is used and in the absence of response or moderate flare, corticosteroids are prescribed. In corticodependent patients, treatment with immunomodulators or biological therapy is started. In severe, corticodependent, or refractory UC, calcineurin inhibitors or anti-TNFa can be administered.

We present the clinical case of a man diagnosed with mild/moderate left UC with disease progression, corticodependence, therapeutic failure to infliximab and intolerance to immunomodulators, who started tacrolimus in the form of an enema with a 2 mg regimen for 5 days a week with good response. With this dosage, a plasma concentration (Pc) of 12.7 ng/mL was determined, so the regimen was adjusted to 1 mg for 4 days a week. With this dose, he maintained a constant Pc and low systemic absorption as well as good control of the disease for five months. Finally, there was an outbreak and the disease could not be controlled despite intensifying the treatment, so it was suspended due to lack of response.

Despite being a treatment that seeks a local topical action, there is a potential risk of reaching high plasma concentrations due to the great interindividual variability of its metabolism as well as the multiple factors involved in rectal absorption. For these reasons, pharmacokinetic monitoring is useful in these patients.

Keywords : Tacrolimus; pharmacokinetics; ulcerative colitis; enema; absortion.

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