Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. (13th January 2020)

• Record Type: Journal Article
• Authors: Martin, Antoine; Nachury, Maria; Peyrin-Biroulet, Laurent; Bouhnik, Yoram; Nancey, Stephane; Bourrier, Anne; Serrero, Melanie; Fumery, Mathurin; Buisson, Anthony; Laharie, David; Gilletta, Cyrielle; Filippi, Jerome; Allez, Matthieu; Bouguen, Guillaume; Roblin, Xavier; Altwegg, Romain; Dib, Nina; Pineton de Chambrun, Guillaume; Savoye, Guillaume; Carbonnel, Franck; Viennot, Stephanie; Amiot, Aurelien
• Is Part Of: Journal of Crohn's and colitis. Volume 14:Number 7(2020)
• Page Start: 896
• Page End: 903
• Publication Date: 2020-01-13
• Subjects: Crohn's disease -- ulcerative colitis -- inflammatory bowel disease -- vedolizumab; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjaa005
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aim: It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. Methods: This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. Results: A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6–25.4] months. After a median follow-up period of 11.2 [5.8–17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33–0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21–0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4–13.3] months, respectively, without any infusion reactions. Conclusions: In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.