Clinical experiences and predictors of success of treatment with vedolizumab in IBD patients: a cohort study

Abstract

Background Vedolizumab has become a standard treatment for the inflammatory bowel diseases ulcerative colitis (UC) and Crohn’s disease (CD). However, there is an ongoing debate on the ideal individual treatment algorithms and means to predict treatment response are not routinely established. Aims We aimed to describe our experiences with vedolizumab at a large German tertiary referral center and to identify clinical predictors of success of vedolizumab treatment. Methods We performed a retrospective single-center cohort study employing univariable and multivariable analyses as well as Kaplan–Meier analyses of persistence on treatment. Results 36% and 35% of the patients with UC and CD, respectively, reached clinical remission after 17 weeks. Patients with lower clinical disease activity were more likely to achieve remission. The median persistence on treatment was 33 months for UC and 29 months for CD. Conclusion Our study confirms that vedolizumab is an efficient option for the treatment of UC and CD. Clinical parameters of disease activity may help to predict the success of treatment.

Circulating Adaptive Immune Cells Expressing the Gut Homing Marker α4β7 Integrin Are Decreased in COVID-19

“…Since these data were only indicating relative expression and not absolute cell numbers, and did not exclude the possibility of coexpression of a4 and b7 integrin without heterodimerization, we seeked to validate our findings in an additional patient cohort. Here, we stained full blood samples and used fluorescently labeled vedolizumab, a monoclonal antibody specific for the a4b7 heterodimer used for the therapy of inflammatory bowel diseases (25). In accordance with previous literature marked lymphopenia was present in COVID-19 patients (Supplementary Figure 3).…”

Clinical response of vedolizumab at week 6 predicted endoscopic remission at week 24 in ulcerative colitis

“… 23 Several studies have assessed endoscopic remission with VDZ; however, the timing of colonoscopic evaluation and remission rate (30–60%) varied among the studies. 24 , 25 , 26 , 27 In our study, the endoscopic remission rate at week 24 was 60.0% (21/35), similar to a previous report evaluating real‐world outcomes. 27 We observed that the cumulative VDZ administration continuation rate was significantly higher in patients who achieved endoscopic remission, and most of the patients in the non‐endoscopic remission group withdrew VDZ within the observation period.…”

“…Narula et al reported that achievement of MES of ≤1 was noted in 29% and 62% patients at week 24 and week 48, respectively, in the VICTORY study 23 . Several studies have assessed endoscopic remission with VDZ; however, the timing of colonoscopic evaluation and remission rate (30–60%) varied among the studies 24–27 . In our study, the endoscopic remission rate at week 24 was 60.0% (21/35), similar to a previous report evaluating real‐world outcomes 27 .…”

Tailoring Multi-omics to Inflammatory Bowel Diseases: All for One and One for All

“…The complexity and heterogeneity of IBD has resulted in a difficult endeavor for the scientific community to attribute causality as well as in raising treatment efficacies above the current therapeutic ceiling marked by endoscopic remission rates of around 30% 27,28 although real world observations recorded slightly higher efficacy rates [29][30][31] . The current standard of care which includes histological examination (used currently only for diagnosis and not for therapeutic endpoints) following endoscopy does not capture the fine-prints of disease biology such as cellular heterogeneities, cell-type specific expression, interactions among cell-types and microbial influences.…”

“…The complexity and heterogeneity of IBD has resulted in a difficult endeavour for the scientific community to attribute causality as well as to raise treatment efficacies above the current therapeutic ceiling marked by endoscopic remission rates of around 30%, 27 , 28 although real-world observations recorded slightly higher efficacy rates. 29–31 The current standard of care, which includes histological examination [used currently only for diagnosis and not for therapeutic endpoints] following endoscopy, does not capture the fine print of disease biology such as cellular heterogeneities, cell type-specific expression, interactions among cell-types, and microbial influences. In response new approaches, like systems biology which integrates high-throughput datasets profiling different layers of biological organisation and the network of molecular interactions, have often been suggested as the ‘holy grail’ for understanding and treating IBD as well as other complex diseases.…”