Two-third of IBD patients relapse within 1 year of Vedolizumab discontinuation and re-treatment is effective in two-third of patients
Pal P, MD,MRCP, reviewing Martin A et al (GETAID-Vedo-STOP study group) in Journal of Crohn’s Colitis , July 2020
In a multi-centre retrospective study from 21 tertiary centres, the effect of discontinuation of Vedolizumab was assessed in 95 patients (58 Crohn’s disease). Relapse free survival was 83%, 59% and 36% after 6, 12 and 18 months of vedolizumab discontinuation. A CRP level (<5 mg/L) and discontinuation due to patients’ elective choice were associated with lower risk of relapse
on multivariate analysis. Disease activity, mucosal healing, type of IBD, reimbursement issues were not significantly associated with risk of relapse. Re-treatment with vedolizumab in 24 patients achieved steroid free clinical remission in 62.5% patients after a median follow up of 11 months.
This data from tertiary care centres provides information on effects of vedolizumab discontinuation in patients with IBD. Although mucosal healing, stool biomarkers measurement and therapeutic drug monitoring (TDM) were not assessed in all the patients due to retrospective design, this real world clinical data is important and currently does not support discontinuation of vedolizumab. A prospective and preferably randomized study with assessment of mucosal healing, stool biomarkers and TDM can provide further information on effects of vedolizumab discontinuation and predictors of maintenance of remission after discontinuation.
Martin A, Nachury M, Peyrin-Biroulet L, et al. Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. J Crohns Colitis. 2020;14(7):896-903. doi:10.1093/ecco-jcc/jjaa005