Combination Therapy Does Not Improve Rate of Clinical or Endoscopic Remission in Patients with Inflammatory Bowel Diseases Treated With Vedolizumab or Ustekinumab

Vedolizumab is currently the only selective biological drug for the treatment of inflammatory bowel diseases (IBD). Its effectiveness and safety has been shown in clinical trials. This article presents the experience of using vedolizumab in real clinical practice in patients with various forms of ulcerative colitis (UC) and Crohns disease (CD). Materials and methods.96 patients with IBD (62 with CD and 34 with UC) were prescribed therapy with vedolizumab at a dose of 300 mg intravenously at 0, 2, and 6 weeks, and further maintenance therapy was continued every 8 weeks. Most patients had prolonged inflammation (27 (79.4%) with total UC, 35 patients with CD (56.5%) had ileocolitis), resistance to therapy, including biological drugs (19 (55.9%) in patients with UC and 49 (79.0%) in patients with CD). The effectiveness of therapy was evaluated after 3 months (based on clinical response and clinical remission), 6 and 12 months (endoscopic response and endoscopic remission were additionally evaluated). Results.After 3 months, clinical remission was observed in 62.5% and 36.6%, respectively. After 6 months, these indicators were 66.7% and 61.0%, and after 12 months, 70.8% and 61.0%, respectively. After 6 months, endoscopic remission was observed in 50.0% of UC patients and 26.8% of CD patients. After 12 months, it reached 58.3% and 31.7%, respectively. The analysis showed greater efficacy in bio-naive patients with CD (steroid-free remission after 12 months 62.5%, endoscopic remission 37.5%), as well as patients with non-stricturizing non-penetrating CD (58%). In patients with UC, vedolizumab showed the same effectiveness both in bio-naive patients (70.0%) and as a second-line therapy (71.2%). It turned out to be more effective in patients with moderate UC (76.2%) and steroid-dependent UC (77.8%). Conclusions.Vedolizumab is effective in achieving clinical response and clinical remission, as well as endoscopic response and endoscopic remission in patients with UC and CD. Given the selective mechanism of action of the drug, it can be recommended as a first-line therapy.

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Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases: One Size Still Does Not Fit All

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2018.02.036 ◽

2018 ◽

Vol 16 (11) ◽

pp. 1829-1831 ◽

Cited By ~ 2

Author(s):

Gil Y. Melmed ◽

Gilaad G. Kaplan ◽

Miles P. Sparrow ◽

Fernando S. Velayos ◽

Leonard Baidoo ◽

...

Keyword(s):

Combination Therapy ◽

Inflammatory Bowel Diseases ◽

Bowel Diseases ◽

Inflammatory Bowel

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Impact of the Duration of Combination Therapy on Clinical and Pharmacological Efficacy of Infliximab in Inflammatory Bowel Diseases

Gastroenterology ◽

10.1016/s0016-5085(17)31561-5 ◽

2017 ◽

Vol 152 (5) ◽

pp. S395

Author(s):

Chloe Vernet ◽

Xavier Roblin ◽

Nicolas Williet

Keyword(s):

Combination Therapy ◽

Inflammatory Bowel Diseases ◽

Bowel Diseases ◽

Inflammatory Bowel

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TOFACITINIB IN THE MANAGEMENT OF ULCERATIVE COLITIS REFRACTORY TO ANTI-TNF AND ANTI-INTEGRIN THERAPIES

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-36 ◽

2018 ◽

Vol 55 (2) ◽

pp. 198-200 ◽

Cited By ~ 1

Author(s):

Fábio Vieira TEIXEIRA ◽

Adérson Omar Mourão Cintra DAMIÃO ◽

Paulo Gustavo KOTZE

Keyword(s):

Ulcerative Colitis ◽

Mechanism Of Action ◽

Inflammatory Bowel Diseases ◽

Lymphocyte Activation ◽

Activation Function ◽

Janus Kinases ◽

Immune Mediated ◽

Endoscopic Remission ◽

Bowel Diseases ◽

Inflammatory Bowel

ABSTRACT Janus kinases inhibitors have already been incorporated into the management of immune-mediated diseases, such as rheumatoid arthritis, and are being investigated for the treatment of psoriasis and inflammatory bowel diseases, both ulcerative colitis and Crohn’s disease. Tofacitinib is an oral small-molecule drug that inhibits Janus kinases 1, Janus kinases 3, and, to a lesser extent, Janus kinases 2. This inhibition ends up blocking signals for several inflammatory cytokines that are involved in the pathogenesis of inflammatory bowel diseases and play a role in many immune signaling routes, including lymphocyte activation, function, and proliferation. We report a patient with active ulcerative colitis with primary non-response to three biologics (infliximab, adalimumab and vedolizumab), with different mechanisms of action, who refused surgical treatment and had a favorable response to tofacitinib with clinical and endoscopic remission. No adverse events were observed with the use of the agent. This case illustrates the difficulties we may face regarding the identification of the expression of proper mechanism of action involved in the pathogenesis of ulcerative colitis patients and the importance of having another treatment option with different mechanism of action, like tofacitinib.

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