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Switch to Entyvio after calcineurin inhibitor induction safe, effective for ulcerative colitis
Transitioning to Entyvio after achieving induction of remission with calcineurin inhibitor therapy is safe and effective for patients with ulcerative colitis, according to study results.
“While highly effective at inducing remission in patients with ulcerative colitis protracted use of calcineurin inhibitors [CNIs] is limited by adverse events, including infection, nephrotoxicity, hypercholesterolemia and hypertension. Consequently, their use in inflammatory bowel disease has been limited to induction therapy,” David T. Rubin, MD, section chief of gastroenterology, hepatology and nutrition, and co-director of the Digestive Diseases Center at the University of Chicago Medicine, and colleagues wrote. “[Entyvio’s (vedolizumab, Takeda)] impressive safety data makes it an ideal candidate agent for use as maintenance therapy in combination with the fast-acting CNIs as induction therapy.”
Researchers conducted a retrospective observational study comprising 71 patients with severe, steroid-refractory UC. They included patients who were induced with CNI therapy followed by maintenance therapy with vedolizumab between 2014 and 2018.
The primary endpoint was colectomy-free survival, and secondary endpoints included survival without vedolizumab discontinuation, and clinical, steroid-free and biochemical remission at week 14.
At 3 months, colectomy-free survival was 93%, and at 2 years it was 55%. At the end of week 14 of vedolizumab treatment, 50% of patients were in clinical remission and 62% had normal C-reactive protein.
One year after vedolizumab initiation, 43% of patients were still on the drug, and 28% remained on it after 2 years. Researchers did not identify any serious adverse events in the cohort.
Rubin and colleagues wrote that their findings show that the transition from CNI to vedolizumab can help a lot of patients avoid colectomy.
“Such a treatment strategy might be considered in patients with steroid-refractory colitis, especially if they had previously failed either anti-TNFs or thiopurines,” they wrote. “Such a strategy enables the introduction of safe protein-based therapies such as vedolizumab following stabilization and induction of remission with CNIs.”
Disclosure: The authors report no relevant financial disclosures.