Extent of Mucosal Inflammation in Ulcerative Colitis Influences the Clinical Remission Induced by Vedolizumab

Abstract

Randomized controlled clinical trials and real-life observations indicate that less than 50% of patients with Crohn’s disease (CD) or ulcerative colitis (UC) respond to vedolizumab, a humanized monoclonal antibody that blocks the α4β7 integrin. Since α4β7-expressing lymphocytes mainly infiltrate the left colon, we assessed whether localization of CD and UC influences vedolizumab-induced remission. One hundred and eighty-one patients (74 CD and 107 UC) receiving vedolizumab in 3 referral centers were retrospectively evaluated for clinical remission at week 14. Demographic and clinical characteristics were compared between remitters and non-responders, and multivariable multinomial analysis was performed to identify predictors of remission. Remission was achieved in 17 CD (23%) and 34 UC (32%) patients, respectively. In CD, localization of the lesions did not influence clinical remission. In UC, the remitters had more frequently a distal/left-sided colitis (21/34, 62%) as compared to the non-responders (9/47, 19%), and extensive colitis was more frequent in the non-responders (38/47, 81%) than in the remitters (13/34, 38%). The multivariable multinomial analysis showed that distal/left-sided colitis was associated with a higher probability of clinical remission while extensive colitis was inversely associated with induction of remission. Data indicate that UC patients with distal or left-sided colitis are more likely to achieve remission than patients with extensive colitis following vedolizumab treatment.

Effect of Vedolizumab on Anemia of Chronic Disease in Patients with Inflammatory Bowel Diseases

“…The induction of clinical response at week 14 was achieved by half of the patients treated with Vedolizumab, thus confirming previous real-life study findings [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. A substantial positive effect of Vedolizumab on ACD was seen in two thirds of the anemic patients.…”

Role of integrin expression in the prediction of response to vedolizumab: A prospective real‐life multicentre cohort study

“…Response rates at w14 were similar as previously reported (Table S3) 1,2 and were not linked with age, gender, age at diagnosis, baseline C-reactive protein (CRP) and previous anti-TNF use. The biochemical response rate was significantly higher in UC patients with left-sided colitis than in those with pancolitis (66.7% vs. 33.3%; p = .015), and similar trend could be observed in endoscopic responders (72.0% vs. 24.0%; p = .066), partially confirming the data of Scarozza et al 4 Current or previous smoking was associated with clinical and endoscopic response in UC (p = .040 and p = .039, respectively) (Table 1).…”

Biomarkers in Inflammatory Bowel Diseases: Predicting the Indication and the Effect of Biologics

“…Crohn's disease location could also predict anti-TNF efficacy, since colonic involvement is associated with higher response and wound healing rates than ileal disease [20][21][22]. Ulcerative colitis patients with less extensive inflammation and distal/left localization of the colitis, as well as CD patients with isolated colitis, non-involving the small intestine, show better outcomes to vedolizumab treatment [57,58]. Ustekinumab also seems less effective for CD patients with ileal disease, although it was helpful to patients with both ileal and colonic involvement [20,137,141].…”