Aims
Vedolizumab is an established treatment for inflammatory bowel disease (IBD). Loss of response is occasionally encountered. Data regarding dose intensification are limited1. Aim of the study was to evaluate the effectiveness of interval shortening for intravenous vedolizumab (300mg/4 weeks).
Methods
Data were collected retrospectively from patients’ medical records, in two Greek tertiary centers. All patients received IV vedolizumab every 4 weeks. Endoscopic and biochemical response was evaluated at 12 months. The intervention was considered successful if treatment was maintained, whereas failure was defined as the need to either switch or operate.
Results
Twenty-one patients [14 (66.7%) men, median age 53 years (range: 25-85 years)] were included. 15 (71.4%) with ulcerative colitis (UC), 4 (19.1%) with Crohn's (CD) and 2 (9.5%) with pouchitis. UC patients: 10 (66.6%) with left-sided colitis (E2) and 5 (33.3%) with extensive disease (E3). All CD patients had ileocolitis (L3), whereas two (50%) had stenotic phenotype and two (50%) perianal involvement. Previous treatments: 5-ASA and corticosteroids (95.2%), immunosuppressants (38.1%) and biologics (57.1%). Vedolizumab was offered as 1st, 2nd and 3rd line treatment in 9, 3 and 9 patients, respectively. Dose intensification was employed after a median duration of 33 months for UC (IQR: 41) and 19.5 months for CD (IQR: 35) (p=0.41). The intensified scheme was applied for a median of 9 months in CD {IQR: 24.5, range 3–48} and 7.5 months in UC {IQR 10, range 3-58, (p=0.98)}. Endoscopic Mayo score decreased from 2.35 to 0.88 and the effect was significant (p = 0.001, r=0.79). The mean CRP value decreased significantly from 1.42 to 0.44 (p = 0.007). Intensification was successful in fourteen (66.7%) cases (11 UC, 2 CD and one pouchitis). Seven patients failed and switched to another biologic. None underwent surgery. No treatment-related adverse events were observed.
Conclusions
Vedolizumab intensification scheme was successfully maintained for the majority of IBD patients, beyond six months. The endoscopic and biochemical responses were both significant.