Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease.

Autor:	Shmidt E; Icahn School of Medicine at Mount Sinai, New York, NY, USA.; University of Minnesota, Minneapolis, MN, USA., Kochhar G; Cleveland Clinic Foundation, Cleveland, OH, USA., Hartke J; Indiana University, Indianapolis, IN, USA., Chilukuri P; Indiana University, Indianapolis, IN, USA., Meserve J; University of California, San Diego, La Jolla, CA, USA., Chaudrey K; Mayo Clinic, Rochester, MN, USA., Koliani-Pace JL; Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA., Hirten R; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Faleck D; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Barocas M; Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA., Luo M; Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA., Lasch K; Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA., Boland BS; University of California, San Diego, La Jolla, CA, USA., Singh S; University of California, San Diego, La Jolla, CA, USA., Vande Casteele N; University of California, San Diego, La Jolla, CA, USA., Sagi SV; Indiana University, Indianapolis, IN, USA., Fischer M; Indiana University, Indianapolis, IN, USA., Chang S; New York University (NYU), New York, NY, USA., Bohm M; Indiana University, Indianapolis, IN, USA., Lukin D; Montefiore Medical Center, New York, NY, USA., Sultan K; North Shore University Hospital, Manhasset, NY, USA., Swaminath A; Lenox Hill Hospital, New York, NY, USA., Hudesman D; New York University (NYU), New York, NY, USA., Gupta N; University of Mississippi, Jackson, MS, USA., Kane S; Mayo Clinic, Rochester, MN, USA., Loftus EV Jr; Mayo Clinic, Rochester, MN, USA., Sandborn WJ; University of California, San Diego, La Jolla, CA, USA., Siegel CA; Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA., Sands BE; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Colombel JF; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Shen B; Cleveland Clinic Foundation, Cleveland, OH, USA., Dulai PS; University of California, San Diego, La Jolla, CA, USA.
Jazyk:	angličtina
Zdroj:	Inflammatory bowel diseases [Inflamm Bowel Dis] 2018 Oct 12; Vol. 24 (11), pp. 2461-2467.
DOI:	10.1093/ibd/izy171
Abstrakt:	Background: We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. Methods: Retrospective review (May 2014-December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. Results: Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn's disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25-2.97] in all patients. For Crohn's disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01-1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. Conclusions: LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.
Databáze:	MEDLINE
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