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Entyvio most effective for UC when used as early first-line treatment

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SAN DIEGO — Entyvio most effectively treated ulcerative colitis when used early and before other steroid-sparing therapeutics, according a presenter at DDW 2016.

“This model predicts that utilizing vedolizumab [Entyvio, Takeda] early in the current treatment paradigm, and particularly before other biologics, may yield the greatest benefit for patients with moderate-to-severe UC when considering the available clinical trial data,” Frank I. Scott, MD, MSCE, from the University of Colorado Anschutz Medical Campus, said during his presentation. “This clinical benefit appears to increase with longer time horizons.”

Frank I. Scott

Using Markov modeling, Scott and colleagues assessed possible treatment algorithms using vedolizumab as a first line steroid-sparing therapy, prior to anti-TNF monotherapy after a thiopurine trial, prior to combination therapy but after anti-TNF or thiopurine monotherapy, prior to combination therapy with a second anti-TNF and as a last-line therapy prior to colectomy.

Using randomized controlled trials such as SUCCESS, ACT 1/2, ULTRA2 and GEMINI, they modeled lymphoma rates, quality-adjusted life years, serious infections and other adverse events, rate of loss of response and time to colectomy.

“Using vedolizumab as first-line steroid-sparing therapy compared to as the last-line therapy in 100,000 simulated individuals over 1 year resulted in 11,294 greater individuals in remission, 817 fewer serious infections and 12 fewer cases of lymphoproliferative disorders,” Scott said.

“In regards to our sensitivity analyses, the preferred strategy remained the first-line vedolizumab use with 25% variation in all transition probabilities,” he said.

Vedolizumab as first-line therapy incurred a QALY benefit of greater than 0.02 QALYs when compared to all other strategies, he added, showing a mean incremental effectiveness of 0.022 to 0.029 QALYs (P < .05).

“In probabilistic analyses, first-line vedolizumab use remained preferred over all other strategies,” Scott said. – by Katrina Altersitz

Reference:

Scott FI, et al. Abstract 511. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosures: Scott reports grant support for this study from Takeda Pharmaceuticals.