Vedolizumab vs TNF antagonists in patients with Crohn's disease

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract often resulting in complications resulting in decreased quality of life. Several classes of medications are available to clinicians including mesalamine, budesonide, systemic corticosteroids, thiopurine derivatives, and monoclonal antibodies which target tumor necrosis factor (TNF). Guidelines generally recommend reserving TNF-antagonists for patients who have failed other first-line therapies; however, emerging data suggests there may be some benefit in combining TNF-antagonists, specifically infliximab, with azathioprine. The purpose of this review is to compare the benefits and risks of combination therapy, and identify patients who may benefit most from this approach.

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Efficacy of vedolizumab for induction of clinical response and remission in patients with moderate to severe inflammatory bowel disease who failed at least two TNF antagonists

United European Gastroenterology Journal ◽

10.1177/2050640617722310 ◽

2017 ◽

Vol 6 (3) ◽

pp. 439-445 ◽

Cited By ~ 7

Author(s):

Martine De Vos ◽

Barbara Dhooghe ◽

Severine Vermeire ◽

Edouard Louis ◽

Fazia Mana ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Response ◽

Disease Activity Score ◽

Real Life ◽

Tnf Antagonists ◽

Mayo Score ◽

Medical Need ◽

Remission Rates ◽

Inflammatory Bowel

Background Vedolizumab is a recently available monoclonal antibody targeting α4β7 integrin for the treatment of ulcerative colitis (UC) and Crohn’s disease (CD). Objective The objective of this article is to evaluate the efficacy of vedolizumab induction therapy in anti-TNF-refractory/intolerant UC and CD patients in real life. Methods A cohort of 149 moderately to severely active UC and CD patients who failed or showed intolerance to at least two TNF antagonists participated in a medical need program and received vedolizumab in 37 Belgian centers (April–September 2015). Rates of clinical response and remission were retrospectively evaluated at Week 10 for UC and Week 14 for CD using the physician’s global assessment (PGA), Mayo score and Harvey Bradshaw index (HBI) or Crohn's disease activity score (CDAI) scores. Results Eighty-four patients (29 UC, 55 CD) had sufficient data for analysis. For UC patients, clinical response was observed in 76% based on PGA and 59% based on the Mayo score. The corresponding percentages for CD patients were 80% for PGA and 65% for HBI/CDAI. Clinical remission rates were 10% and 40% for UC and CD, respectively. Steroid-free remission was observed in respectively 10% and 35%. Globally, corticosteroids were stopped in 14 out of 48 patients (29%). No new safety signals were reported. Conclusion Up to 70% TNF-refractory/intolerant UC and CD patients achieved a clinical response after 10 to 14 weeks of vedolizumab treatment in this real-life cohort.

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Tocilizumab in a patient with ankylosing spondylitis and Crohn's disease refractory to TNF antagonists

Joint Bone Spine ◽

10.1016/j.jbspin.2010.08.004 ◽

2010 ◽

Vol 77 (6) ◽

pp. 625-626 ◽

Cited By ~ 51

Author(s):

Laure Brulhart ◽

Michael J. Nissen ◽

Paola Chevallier ◽

Cem Gabay

Keyword(s):

Crohn’S Disease ◽

Ankylosing Spondylitis ◽

Crohn's Disease ◽

Tnf Antagonists

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Surgery and biologic use pattern for patients with crohn's disease who initiated tnf antagonists in a managed care setting in the United States

Value in Health ◽

10.1016/j.jval.2013.03.1005 ◽

2013 ◽

Vol 16 (3) ◽

pp. A199

Author(s):

K. Gorcyca ◽

J. Muszka ◽

V. Herrera ◽

H. Wang ◽

M.T. Covington ◽

...

Keyword(s):

United States ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Managed Care ◽

Care Setting ◽

The United States ◽

Tnf Antagonists ◽

Use Pattern

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Early use of immunosuppressives or TNF antagonists for the treatment of Crohn's disease: time for a change

Gut ◽

10.1136/gutjnl-2011-300934 ◽

2011 ◽

Vol 60 (12) ◽

pp. 1754-1763 ◽

Cited By ~ 82

Author(s):

I. Ordas ◽

B. G. Feagan ◽

W. J. Sandborn

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Tnf Antagonists ◽

Early Use

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Pre-operative Exposure to Ustekinumab: A Risk Factor for Postoperative Complications in Crohn's Disease (CD)?

Current Drug Targets ◽

10.2174/1389450120666190515094435 ◽

2019 ◽

Vol 20 (13) ◽

pp. 1369-1372 ◽

Cited By ~ 1

Author(s):

Hang Hock Shim ◽

Christopher Ma ◽

Paulo Gustavo Kotze ◽

Remo Panaccione

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tract ◽

Biologic Therapy ◽

Safety Data ◽

Biologic Therapies ◽

Intestinal Surgery ◽

Tnf Antagonists ◽

Number Of Patients ◽

Chronic Inflammatory Condition

Crohn’s disease (CD) is a chronic inflammatory condition of the intestinal tract that is characterised by a relapsing and remitting course. Despite advancements in therapeutic options for CD, a substantial number of patients still require surgery for medically refractory disease or disease-related complications. Given the widespread adoption of biologic therapies for the management of patients with moderate-to-severe CD, a high number of patients are likely to be on biologic therapy at the time of needing intestinal surgery: the safety of biologics in perioperative setting is of great interest. While more clinical data are available for TNF antagonists and vedolizumab, the safety data for ustekinumab, an IL 12/23 inhibitor, is lacking. Here, we review the available data from published literature on the postoperative outcomes for CD patients exposed to ustekinumab perioperatively.

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