Vedolizumab for induction and maintenance of remission in Crohn's disease

Hui, Samuel; Sinopoulou, Vassiliki; Gordon, Morris; Aali, Ghazaleh; Krishna, Anuj; Ding, Nik Sheng; Boyapati, Ray

doi:10.1002/14651858.cd013611.pub2

Cited by 3 publications

(1 citation statement)

References 33 publications

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“…Vedolizumab, a monoclonal antibody that binds the integrin a4b7 heterodimer and blocks its interaction with MAdCAM-1 is another potential option. This prevents leukocyte binding to endothelial surface and its extravasation into inflamed tissue and is proven to be effective in Crohn's disease [57]. A study of its use in 11 patients showed subjective clinical improvement in 7 and mucosal improvement in more than half, but the response was short-lived [58].…”

Section: Treatmentmentioning

confidence: 99%

Inflammatory Complications in Chronic Granulomatous Disease

Grammatikos,

Gennery

2024

JCM

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Chronic granulomatous disease (CGD) is a rare inborn error of immunity that typically manifests with infectious complications. As the name suggest though, inflammatory complications are also common, often affecting the gastrointestinal, respiratory, urinary tracts and other tissues. These can be seen in all various types of CGD, from X-linked and autosomal recessive to X-linked carriers. The pathogenetic mechanisms underlying these complications are not well understood, but are likely multi-factorial and reflect the body’s attempt to control infections. The different levels of neutrophil residual oxidase activity are thought to contribute to the large phenotypic variations. Immunosuppressive agents have traditionally been used to treat these complications, but their use is hindered by the fact that CGD patients are predisposed to infection. Novel therapeutic agents, like anti-TNFa monoclonal antibodies, anakinra, ustekinumab, and vedolizumab offer promise for the future, while hematopoietic stem cell transplantation should also be considered in these patients.

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Section: Treatmentmentioning

confidence: 99%

Inflammatory Complications in Chronic Granulomatous Disease

Grammatikos,

Gennery

2024

JCM

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Vedolizumab for induction and maintenance of remission in Crohn's disease

Hui

Sinopoulou

Gordon

et al. 2023

Cochrane Database of Systematic Reviews

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Background Vedolizumab blocks inflammatory activity within the gastrointestinal tract. Systematic reviews have demonstrated the efficacy of vedolizumab in ulcerative colitis and inflammatory bowel disease in general. This systematic review and meta‐analysis summarises the current evidence of vedolizumab in the induction and maintenance of remission in Crohn's disease. Objectives To evaluate the benefits and harms of vedolizumab versus placebo for the induction and maintenance of remission in people with Crohn's disease. Search methods We used standard, extensive Cochrane search methods. The latest search date was 30 November 2022. Selection criteria We included randomised controlled trials (RCTs) and quasi‐RCTs comparing vedolizumab to placebo for the induction or maintenance of remission in people with Crohn's disease. Data collection and analysis We used standard Cochrane methods. For induction studies, the primary outcome was 1. clinical remission, and secondary outcomes were rates of 2. clinical response, 3. adverse events, 4. serious adverse events, 5. surgery, 6. endoscopic remission and 7. endoscopic response. For maintenance studies, the primary outcome was 1. maintenance of clinical remission, and secondary outcomes were rates of 2. adverse events, 3. serious adverse events, 4. surgery, 5. endoscopic remission and 6. endoscopic response. We used GRADE to assess certainty of evidence. Main results We analysed induction (4 trials, 1126 participants) and maintenance (3 trials, 894 participants) studies representing people across North America, Europe, Asia and Australasia separately. One maintenance trial administered subcutaneous vedolizumab whilst the other studies used the intravenous form. The mean age ranged between 32.6 and 38.6 years. Vedolizumab was superior to placebo for the induction of clinical remission (71 more per 1000 with clinical remission with vedolizumab; risk ratio (RR) 1.61, 95% confidence interval (CI) 1.20 to 2.17; number needed to treat for an additional beneficial outcome (NNTB) 13; 4 studies; high‐certainty evidence) and superior to placebo for inducing clinical response (105 more per 1000 with clinical response with vedolizumab; RR 1.43, 95% CI 1.19 to 1.71; NNTB 8; 4 studies; high‐certainty evidence). For the induction phase, vedolizumab may be equivalent to placebo for the development of serious adverse events (9 fewer serious adverse events per 1000 with vedolizumab; RR 0.91, 95% CI 0.62 to 1.33; 4 studies; low‐certainty evidence) and probably equivalent to placebo for overall adverse events (6 fewer adverse events per 1000 with vedolizumab; RR 1.01, 95% CI 0.93 to 1.11; 4 studies; moderate‐certainty evidence). Vedolizumab was superior to placebo for the maintenance of clinical remission (141 more per 1000 with maintenance of clinical remission with vedolizumab; RR 1.52, 95...

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Case report: Vedolizumab in Oral Crohn’s disease: the downsides of a gut-specific therapy for a multi-site disease

Harte,

Macken,

Zou

et al. 2024

Front. Med.

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IntroductionCrohn’s disease (CD) is a chronic inflammatory bowel disease which can affect any area of the gastrointestinal tract, including oral tissues. The complex nature of this disease demands interdisciplinary management, especially when both intestinal and oral manifestations are present.CaseThis report presents the case of a 28-year-old male patient with oral, ileo-caecal and peri-anal CD managed jointly between Gastroenterology and Oral Medicine. Treatment with vedolizumab, an α4β7 integrin with gut-selective anti-inflammatory activity, resulted in excellent ileo-caecal disease control, but was ineffective in controlling oral manifestations. The absence of MAdCAM-1 expression in oral tissues, necessary for vedolizumab’s mechanism, meant that the drug’s anti-inflammatory effects were limited to the gut. This limitation led to worsening oral symptoms, necessitating concomitant azathioprine therapy to manage oral inflammation.ConclusionMultidisciplinary collaboration is important when managing CD patients with both oral and gut involvement in CD. Clinicians should be aware that vedoluzimab may be beneficial for intestinal CD, but does not target inflammation in oral tissues due to its gut-specific action. Good knowledge of the pharmacology and mechanism of action of drugs prescribed can aid decision making when prescribing for this group of patients and can limit the need for polypharmacy, often associated with an increased adverse effect profile.

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Vedolizumab for induction and maintenance of remission in Crohn's disease

Cited by 3 publications

References 33 publications

Inflammatory Complications in Chronic Granulomatous Disease

Inflammatory Complications in Chronic Granulomatous Disease

Vedolizumab for induction and maintenance of remission in Crohn's disease

Case report: Vedolizumab in Oral Crohn’s disease: the downsides of a gut-specific therapy for a multi-site disease

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