Standard and modified vedolizumab dosing is effective in achieving clinical and endoscopic remission in moderate‐severe Crohn's disease. Issue 1 (15th January 2021)

• Record Type: Journal Article
• Authors: Lee, Scott D.; Singla, Anand; Clark‐Snustad, Kindra
• Is Part Of: GastroHep. Volume 3:Issue 1(2021)
• Page Start: 26
• Page End: 36
• Publication Date: 2021-01-15
• Subjects: Crohn's disease -- modified dosing -- optimising therapy -- remission -- vedolizumab; Gastroenterology -- Periodicals; Hepatology -- Periodicals; 616.33
• DOI: 10.1002/ygh2.438
• Languages: English
• ISSNs: 2689-3711

Abstract

Abstract: Background/Aims: Vedolizumab is effective for moderate‐severe Crohn's disease. Dose optimisation may improve outcomes. We evaluated the safety and effectiveness of standard and modified maintenance vedolizumab dosing in patients with Crohn's disease. Methods: We retrospectively assessed clinical, laboratory and endoscopic endpoints prior to and following standard vedolizumab dosing. In non‐remitters to standard dosing who received modified vedolizumab maintenance dosing, we assessed disease measures prior to and following modified dosing. We documented adverse events. Results: We identified 226 eligible patients, mean age 41.5 years, 55.3% female, median disease duration 10 years and 88.9% with prior biologic exposure. Mean treatment duration was 28.0 months. After standard dosing, 61.7% and 41.7% of patients achieved clinical response and remission respectively. In 50.0%, C. reactive protein (CRP) normalised. Respectively, 52.9%, 42.3% and 26.0% achieved endoscopic improvement, endoscopic remission and endoscopic healing. Seventy non‐remitters to standard dosing received 300 mg IV every 4 or 6 weeks. After modified dosing, 50.0% and 44.1% achieved clinical response and remission respectively. In 52.6%, CRP normalised. Of patients with Simple Endoscopic Score ≥3 prior to dose modification, 27.8% achieved endoscopic improvement and 22.2% achieved endoscopic healing. About 60.6% of patients reported ≥1 adverse event, most commonly infection and worsening bowel symptoms. No new safety signals observed. Conclusions: Standard vedolizumab dosing resulted in clinical and endoscopic improvement in Crohn's disease patients with a significant inflammatory burden and prior failure of multiple advanced therapies. For non‐remitters to standard dosing, modified maintenance dosing improved clinical disease activity in 50% and endoscopic disease activity in greater than 20% of patients.