Influence of disease location on Vedolizumab effectiveness in inflammatory bowel diseases: a real-life multicenter experience

Overview & Synopsis

Background: influence of inflammatory bowel disease (IBD) location on Vedolizumab effectiveness is unclear. Objective: determine if IBD location is a predictive factor of steroid-free clinical remission (SFCR) at week 24 under Vedolizumab. Methods: from 2014 to 2017, all patients with moderate to severe Crohn disease (CD) and Ulcerative Colitis (UC) receiving Vedolizumab in Grenoble and Lyon-Sud University Hospitals were included in a retrospective multicenter study. SFCR was defined by a Harvey-Bradshaw Index (HBI) < or = 4 for CD and a Partial Mayo Score (PMS) < or = 2 with each sub-score of 1 or less for UC, with corticosteroids withdrawn for at least 1 month. Disease location was defined according to Montreal classification. Results: 133 CD and 90 UC were included. At week 24, SFCR was achieved in 33.1 % (n=44/133) CD patients and 33.3% (n=30/90) UC patients. In CD, SFCR rates were 33%, 36% and 35%, respectively for L1, L2 and L3 disease locations (p=0.906), with no difference when isolated colonic disease (L2) was compared to ileal disease (L1 and L3), (p=0.928). In UC, SFCR rates were 37% and 31%, respectively for distal UC (E1, E2) and pancolitis (E3), (p=0.594). SFCR at week 24 was achieved in 17% of CD patients with active perineal disease versus 42% of CD patients without active perineal disease (p=0.037). Conclusion: apart for active perineal CD, SFCR at week 24 under Vedolizumab therapy was not associated with IBD location. A prospective study, with rigorous assessment of disease and flare locations is required.