P615 Efficacy of vedolizumab in patients with Crohn's disease may differ depending on the disease location: The UCLH experience. (16th January 2018)

• Record Type: Journal Article
• Authors: Kumagai, T; Vinayaga-Pavan, M; Parisi, I; Barragry, J; Sundramoorthi, R; Whitley, L; Parker, H; Kettle, R; McCabrey, N; Seward, E; McCartney, S; Bloom, S; Vega, R; Mehta, S; Rahman, F
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S420
• Page End: S421
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.742
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Vedolizumab is α4β7 integrin antagonist licenced to treat moderate to severely active Crohn's disease (CD) as well as ulcerative colitis. The aim of this study was to examine the efficacy of vedolizumab in patients with CD at a single tertiary IBD centre in the UK, and whether efficacy varies depending on disease location in this heterogeneous condition. Methods: Clinical records of patients with CD commenced on vedolizumab between 11/05/2015 and 01/12/2016 were examined retrospectively. Clinicopathological features and disease activity using Harvey Bradshaw Activity Index (HBAI) were collected at baseline, and at Weeks 14, 30 and at Week 52. Response to vedolizumab was defined as reduction in HBAI score ≤3 compared with baseline, and remission was defined as HBAI score ≤4 at these time points. For patients with a stoma, response was defined as a reduction in CRP ≥ 20% or radiological improvement, and remission was defined as normalisation of CRP ≤ 10 mg/l or radiological resolution of disease activity. Results: Forty patients with CD were commenced on vedolizumab during the study period. Out of the 40 patients, 8 were excluded from the data analysis due to incomplete data. Eighteen patients (57%) had ileocolonic disease, 11 patients (34%) had colonic disease, and 3 patients (9%) had small-bowel disease. Mean age at the time of first Vedolizumab infusion was 29.3. Mean age at diagnosis was 18.1 with mean time between diagnosis and first vedolizumab infusion of 10.1 years. Twenty-one patients (66%) were taking immunomodulator (IM) and only 1 patient was anti-TNF naïve (3%) at the time of the first vedolizumab infusion. Sixteen patients had undergone previous surgery. Mean faecal calprotectin at baseline was 1948 μg/g. At Week 14, 3 patients responded (9%), 14 (44%) were in remission and 15 (47%) did not respond. Out of 23 patients who continued vedolizumab to Week 30, 1 patient responded (4%), 14 were in remission (61%), and 8 (35%) did not show response. Out of 18 patients who continued vedolizumab for 1 year, 10 (56%) were in remission. Out of these 10 patients, 4 had colonic disease and 6 had ileocolonic disease. The three patients with small-bowel disease were all non-responders. The rate of remission at 1 year was lower in the patients with concomitant use of IM ( n = 5/21, 24%) compared with IM ( n = 5 of 11, 45%). Six patients underwent surgery within 1 year of receiving their first vedolizumab infusion. Conclusions: CD patients treated with vedolizumab achieved remission in 44% at Week 14, in 44% at 30 weeks and in 31% at Week 52. Vedolizumab was most effective at maintaining remission at 52 weeks in patients with colonic disease ( n = 4 of 9, 44%) compared with patients with ileocolic disease ( n = 6 of 20, 30%) and patients with small-bowel disease ( n = 0 of 3, 0%).