Histopathological predictor of response to mirikizumab in active ulcerative colitis
Ichitaro Horiuchi1, Akira Horiuchi2, Kaori Horiuchi3
1Department of Gastroenterology, Shinshu University Hospital, Matsumoto, Japan.
This case series reports three patients with active ulcerative colitis (UC) successfully treated with mirikizumab, a selective IL-23p19 monoclonal antibody. Mirikizumab was initiated based on both clinical presentation and a histopathological marker-high neutrophilic infiltration of the colonic epithelium classified as Geboes Grade 3.2-which reflects an IL-23/Th17-driven inflammatory phenotype. The cases included: an elderly man with acute severe pancolitis and primary nonresponse to infliximab; a middle-aged woman with steroid-dependent left-sided UC and inadequate response to adalimumab and ustekinumab; and a young biologic-naïve woman with steroid-refractory UC and bowel urgency. All three patients demonstrated high epithelial neutrophilic infiltration (Geboes Grade 3.2). These cases demonstrate the potential utility of histology-guided biologic selection and support Geboes Grade 3.2 as a candidate predictive biomarker for IL-23 inhibitor response in UC.
This case series reports three patients with active ulcerative colitis (UC) successfully treated with mirikizumab, a selective IL-23p19 monoclonal antibody. Mirikizumab was initiated based on both clinical presentation and a histopathological marker-high neutrophilic infiltration of the colonic epithelium classified as Geboes Grade 3.2-which reflects an IL-23/Th17-driven inflammatory phenotype. The cases included: an elderly man with acute severe pancolitis and primary nonresponse to infliximab; a middle-aged woman with steroid-dependent left-sided UC and inadequate response to adalimumab and ustekinumab; and a young biologic-naïve woman with steroid-refractory UC and bowel urgency. All three patients demonstrated high epithelial neutrophilic infiltration (Geboes Grade 3.2). These cases demonstrate the potential utility of histology-guided biologic selection and support Geboes Grade 3.2 as a candidate predictive biomarker for IL-23 inhibitor response in UC.
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