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Crohn’s duration linked to Entyvio response
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Patients who have Crohn’s disease for two years or less are more likely to experience complete and endoscopic response with Entyvio, according to research published in Clinical Gastroenterology and Hepatology.
Parambir S. Dulai, MD, of the division of gastroenterology at the University of California San Diego, and colleagues wrote that the bowel damage that occurs over time in CD can lead to irreversible complications.
“There appears to be an optimal window of opportunity in which early effective intervention may improve outcomes and alter the natural history of the disease, akin to the evolving practice in rheumatoid arthritis,” they wrote. “Whether this treatment-modifying effect of early disease duration is unique to the TNF antagonist drug class or extends to other treatment agents is not clear.”
Researchers analyzed data from a retrospective, multicenter consortium of patients with CD (n = 650) or ulcerative colitis (n = 437) who were treated with Entyvio (vedolizumab, Takeda) from 2014 to 2016. They grouped patients based on disease duration (early-stage, no more than two years; later-stage, more than two years) and compared rates of clinical remission, corticosteroid-free remission and endoscopic remission between the groups.
Investigators found that within 6 months of treatment, higher proportions of patients with early-stage CD achieved clinical remission (38% vs. 23%) and endoscopic remission (29% vs. 13%; both P < .05) compared with patients with later stage CD. The improved response persisted in all three endpoints after researchers controlled for other predictors of treatment outcome, including previous anti-TNF exposure (clinical remission, adjusted HR = 1.59; 95% CI, 1.02-2.49; steroid-free remission, aHR = 3.39; 95% CI, 1.66-6.92; endoscopic remission, aHR = 1.9, 95% CI, 1.06-3.39).
Among patients with UC, disease duration had no significant predictive value for response to vedolizumab.
“The combined safety and efficacy of vedolizumab makes it an attractive candidate for early, aggressive intervention in hopes of achieving lasting disease modification,” Dulai and colleagues concluded. “Further studies are needed to explore the impact of early use of vedolizumab on long-term outcomes and its ability to prevent disease progression in both CD and UC.” – by Alex Young
Disclosures: Dulai reports receiving research support, honorarium and travel support from Takeda, as well as research support from Pfizer. He also served on the advisory board for Janssen. Please see the full study for all other authors’ relevant financial disclosures.
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