The Use of Vedolizumab in Preventing Postoperative Recurrence of Crohn’s Disease

Yamada, Akihiro; Komaki, Yuga; Patel, Nayan; Komaki, Fukiko; Pekow, Joel; Dalal, Sushila; Cohen, Russell D.; Cannon, Lisa; Umanskiy, Konstantin; Smith, Radhika; Hurst, Roger D.; Hyman, Neil; Rubin, David T.; Sakuraba, Atsushi

doi:10.1093/ibd/izx054

Cited by 53 publications

(40 citation statements)

References 23 publications

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“…Altogether 87 articles were selected for detailed evaluation, among which 24 articles were included (Figure 1). Generally, articles originated from Europe, 21‐36 Japan, 28,37‐41 the United States 42,43 and Oceania, 44 comprising 11 RCTs, 23,26,29,32,34,36,38,39,41,43,44 and 13 cohort or case‐control studies 21,22,24,25,27,28,30,31,33,35,37,40,42 . Most of the articles prescribed anti‐TNF‐α therapy, either with infliximab or adalimumab, with one article using vedolizumab.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 1042 participants were prescribed biologics as prophylaxis for the prevention of POR. Endoscopic recurrence was defined according to a Rutgeerts' score >i2, 5 and SES‐CD, 42 while the definition of clinical remission varied across studies. A summary of the included articles can be found in Table S1 and the results of quality assessment can be found in Table S2 and Figure S1.…”

Section: Resultsmentioning

confidence: 99%

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Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta‐analysis

Jain

Chin

et al. 2021

J of Digest Diseases

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Objective Preventing the postoperative recurrence (POR) of Crohn's disease (CD) poses a significant challenge to clinicians. With the advent of biologics, various studies have observed a reduction of recurrence after surgery. Hence, we performed a systematic review and meta‐analysis to identify the rate of POR at different time points in the era of biologic use. Methods We performed a literature search using Medline and Embase databases for studies investigating biologics in preventing the POR of CD. Data were extracted, and a single‐arm meta‐analysis with generalized linear mixed model and Clopper‐Pearson method for confidence interval (CI) was performed to identify endoscopic, clinical and surgical recurrence rates at 6 months and 1, 2 and 5 years postoperatively. Results Altogether 24 studies were included in the meta‐analysis. The endoscopic, clinical and surgical POR rate with the use of anti‐tumor necrosis factor (TNF)‐α agents at 1 year was 21.72% (95% CI 16.28%‐28.37%), 13.06% (95% CI 8.18%‐18.92%) and 3.76% (95% CI 1.37%‐9.91%), respectively. The 5‐year recurrence rate was 84.21% (95% CI 72.35%‐91.57%) and 17.49% (95% CI 9.17%‐30.80%) for endoscopic and surgical recurrence, respectively. Subgroup analyses at 1 year for the type of anti‐TNF‐α agent or the timing of initiation after surgery showed no significant difference in endoscopic, clinical and surgical recurrence rates. Conclusions Anti‐TNF‐α agents are effective at preventing clinical, endoscopic and surgical POR of CD. The timing of initiating biological therapy after surgery has no significant effect on the rate of POR. The efficacy of infliximab and adalimumab for postoperative recurrence prevention is similar.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta‐analysis

Jain

Chin

et al. 2021

J of Digest Diseases

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“…71-19.4, p = 0.005). 67 However, there were a multitude of confounding factors and limitations to this analysis including key population differences. 68 There is limited data assessing the efficacy of vedolizumab in treating POR.…”

Section: Biologic Therapies For Postoperative CD Recurrencementioning

confidence: 99%

Medical therapies for postoperative Crohn’s disease

Shah

Click

2021

Therap Adv Gastroenterol

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Postoperative recurrence of Crohn’s disease is common and requires a multidisciplinary approach between surgeons and gastroenterologists in the perioperative and postoperative period to improve outcomes in this patient population. Endoscopic recurrence precedes clinical and surgical recurrence and endoscopic monitoring is crucial to guide postoperative management. Risk stratification of patients is recommended to guide early prophylactic management, and follow-up endoscopic monitoring can guide intensification of therapy. This review summarizes evidence behind postoperative recurrence rates, disease monitoring techniques, nonbiologic and biologic therapies available to prevent and treat postoperative recurrence, risk factors associated with recurrence, and postoperative management strategies guided by endoscopic monitoring.

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“…The effectiveness in preventing postoperative recurrence is unknown. In retrospective study of patients who underwent CD-related surgery, it was found that the rate of endoscopic remission at 6–12 months in the vedolizumab group was 25%, which was significantly lower than that in the anti-TNF group (66%, p = 0.01) [71]. Further prospective multicenter studies are urgently needed.…”

Section: Vedolizumab In Special Populationmentioning

confidence: 99%

Vedolizumab in Inflammatory Bowel Disease: West versus East

Debnath¹,

Rathi²

2021

Inflamm Intest Dis

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Background: Vedolizumab is a humanized immunoglobulin G1 monoclonal antibody, which binds to α4β7 integrin on T lymphocytes, thus disturbing the interaction with mucosal vascular addressin cell adhesion molecule 1 on the intestinal endothelial cells to interfere with lymphocyte trafficking to the gut. Summary: Vedolizumab is a safe and effective drug to induce and maintain clinical remission in patients with Crohn’s disease (CD) and ulcerative colitis (UC) in both clinical trials and real-world data. Various guidelines recommend vedolizumab as a first- or second-line treatment regimen for steroid-dependent, steroid, or immunomodulator refractory cases of UC and CD; however, it is more effective in anti-TNF-naive patients. The first head-to-head trial (VARSITY trial) comparing the efficacy of vedolizumab to adalimumab has shown better clinical remission and mucosal healing with vedolizumab. Key Messages: In this review, we have discussed guidelines recommendation of vedolizumab use, as well as its safety data, use in special population, in presence of extraintestinal complications, therapeutic drug monitoring, data from Asian patients, along with other evolving concepts. Because of its excellent safety data and low immunogenicity, vedolizumab is an impressive option for patients with prior malignancy and less chance of reactivation of tuberculosis; however, cost remains an issue.

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The Use of Vedolizumab in Preventing Postoperative Recurrence of Crohn’s Disease

Cited by 53 publications

References 23 publications

Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta‐analysis

Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta‐analysis

Medical therapies for postoperative Crohn’s disease

Vedolizumab in Inflammatory Bowel Disease: West versus East

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