1. Oral Vancomycin as a Therapeutic Option for PSC
Yinka Davies, MD
Adjunct Clinical Assistant Professor, Stanford School of Medicine
PSC Partners Seeking a Cure 2018 Annual Conference
June 23, 2018

2. About oral vancomycin
Glycopeptide antibiotic for Gram-positive bacteria, targeting the colon
Commonly used to treat Clostridium difficile (C. diff)-associated diarrhea
Not absorbed by the gut

3. Case study 15 year old boy with PSC, IBD and C. diff infection
Liver tests decreased and PSC symptoms subsided
After course of vancomycin, elevated labs and symptoms returned
A second course of treatment provided same improvements

4. Case study – cont.
Repeated in multiple PSC patients without C.diff infection and has been treating PSC this way since (79+ patients treated, 75 responded between Dr. Cox & Dr. Davies)

5. Treatment regimen 50 mg/kg/day, typically 500mg 3 times/day
Long-term therapy
Brand or brand generic (ANI)
Early stage disease (Stages 0-2)

6. Liver function tests

7. Liver function tests
# times above max
# times above max

8. Symptoms
Itching, fatigue, diarrhea, weight loss typically subside within first month or two of treatment
No common related adverse events reported
VRE uncommon (0.03%-0.68%)1 - not absorbed by the gut

9. Pathology Improvement or at least no progression on annual:
Liver biopsy
Colonoscopy (Inflammatory Bowel Disease)
Reduced inflammation in non- cirrhotic patients

10. Pathology - PSC Liver biopsy results (13 patients)
9 showed decrease in disease
3 showed no histologically evident increase or decrease in pathology
1 showed stigmata of increased pathology/disease progression

11. Pathology - IBD Endoscopy results (11 patients)
7 changed from chronic active colitis to unremarkable colonic mucosa or chronic inactive colitis
4 had no change:
2 consistent chronic active colitis in before & after
2 no pathologic abnormalities in before & after

12. Next steps A standardized treatment protocol Dosing
Duration of treatment
Monitoring for response to therapy
Adult vs. pediatric
Other therapies
C. diff now being treated with FMT

13. References
1. Remschmidt C, Behnke M, Kola A, et al. The effect of antibiotic use on prevalence of nosocomial vancomycin-resistant enterococci - an ecologic study. Antimicrob Resist Infect Control. 2017;6:95.
2. Davies YK, Cox KM, Abdullah BA, Safta A, Terry AB, Cox KL: Long-term treatment of primary sclerosis cholangitis in children with oral vancomycin: an immunomodulating antibiotic. Journal of Pediatric Gastroenterology and Nutrition, 47(1): 61-7, July 2008.