Crohn's disease: vedolizumab response is higher in early disease

  • Clin Gastroenterol Hepatol

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Vedolizumab (Entyvio) shows greater response in patients with Crohn's disease (CD) with early-stage disease (≤2 years duration) than those with late-stage disease (>2 years).
  • The effect was absent in ulcerative colitis (UC).

Why this matters

  • Consider prescribing vedolizumab earlier in the course of CD.
  • Similar effect of disease duration seen with TNF inhibitors.

Study design

  • Retrospective multicenter cohort of patients with CD (n=650) and UC (n=437) treated with vedolizumab in the VICTORY Consortium.
  • Outcomes were clinical remission (complete remission of symptoms on clinical evaluation), corticosteroid-free remission (CSFR; remission after tapering off corticosteroids and no repeat corticosteroids within 4 weeks of tapering), and endoscopic remission (absence of ulcers or erosions by endoscopy).
  • Funding: Takeda Pharmaceuticals USA, Inc.

Key results

  • Early-stage CD (vs late-stage) is associated with greater likelihood of achieving these types of remission, after adjusting for disease-related factors including earlier exposure to TNF inhibitors:
    • clinical remission (adjusted HR [aHR], 1.59; 95% CI, 1.02-2.49),
    • CSFR (aHR, 3.39; 95% CI, 1.66-6.92), and
    • endoscopic remission (aHR, 1.90; 95% CI, 1.06-3.39).
  • No differences in early- vs late-stage disease response to vedolizumab in patients with UC.

Limitations

  • Retrospective, observational design.
  • Lack of well-validated methods to study treatment remission.