Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease. Issue 11 (18th May 2018)

• Record Type: Journal Article
• Authors: Shmidt, Eugenia; Kochhar, Gursimran; Hartke, Justin; Chilukuri, Prianka; Meserve, Joseph; Chaudrey, Khadija; Koliani-Pace, Jenna L; Hirten, Robert; Faleck, David; Barocas, Morris; Luo, Michelle; Lasch, Karen; Boland, Brigid S; Singh, Siddharth; Vande Casteele, Niels; Sagi, Sashidhar Varma; Fischer, Monika; Chang, Shannon; Bohm, Matthew; Lukin, Dana; Sultan, Keith; Swaminath, Arun; Hudesman, David; Gupta, Nitin; Kane, Sunanda; Loftus, Edward V; Sandborn, William J; Siegel, Corey A; Sands, Bruce E; Colombel, Jean-Frederic; Shen, Bo; Dulai, Parambir S;
• Is Part Of: Inflammatory bowel diseases. Volume 24:Issue 11(2018)
• Page Start: 2461
• Page End: 2467
• Publication Date: 2018-05-18
• Subjects: inflammatory bowel disease -- Crohn's disease -- ulcerative colitis -- biologics; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy171
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. Methods: Retrospective review (May 2014–December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. Results: Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn's disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25–2.97] in all patients. For Crohn's disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01–1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. Conclusions: LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.