Sustained Clinical Remission With Vedolizumab in Patients With Moderate-to-Severe Ulcerative Colitis

Feagan BG1, Schreiber S2, Wolf DC3, Axler JL4, Kaviya A5, James A5, Curtis RI5, Geransar P6, Stallmach A7, Ehehalt R8, Bokemeyer B9, Khalid JM5, O'Byrne S6. Inflamm Bowel Dis. 2018 Oct 25. doi: 10.1093/ibd/izy323. [Epub ahead of print]

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1 Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.

2 Department of Internal Medicine I, Kiel University, Kiel, Germany.

3 Atlanta Gastroenterology Associates, Atlanta, Georgia, USA.

4 Toronto Digestive Disease Associates, University of Toronto, Toronto, Ontario, Canada.

5 Takeda International - UK Branch, London, United Kingdom.

6 Takeda Pharmaceuticals International AG, Zurich, Switzerland.

7 Department of Internal Medicine IV, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany.

8 Gastroenterology Outpatient Clinic, Heidelberg, Germany.

9 Gastroenterology Practice, Minden, Germany.


BACKGROUND: Sustaining clinical remission is an important treatment goal in moderate-to-severe UC. This post hoc exploratory analysis assessed the long-term efficacy of vedolizumab in the subset of patients with UC in the GEMINI 1 study who were in clinical remission by week 14 after 3 induction doses, administered at weeks 0, 2, and 6.

METHODS: Sustained clinical remission (primary endpoint) was evaluated using 2 definitions: (1) a partial Mayo Score (pMS) of ≤2 with no subscore >1 and (2) a rectal bleeding subscore (RBS) of 0 throughout weeks 14, 26, 38, and 52.

RESULTS: The proportion of patients in clinical remission at week 14 was significantly higher in patients receiving vedolizumab (n = 620) compared with placebo (n = 149) (pMS: 32.7% vs 20.1% [percentage-point difference (∆) 12.6%; 95% confidence interval [CI], 5.2-20.0]; RBS: 47.3% vs 28.9% [∆18.4%; 95% CI, 10.1-26.7]). Of patients in clinical remission at week 14, a significantly higher proportion of vedolizumab-treated patients achieved sustained clinical remission compared with placebo (pMS: 66.5% vs 26.7%; ∆39.8%; 95% CI, 22.7-56.9; RBS: 56.7% vs 20.9%; ∆35.7%; 95% CI, 22.3-49.1). Findings were consistent in tumor necrosis factor (TNF) antagonist-naive and antagonist-failure patients.

CONCLUSION: Compared with placebo, 35%-40% more patients receiving a full induction course of vedolizumab had sustained clinical remission after 52 weeks of therapy. This result was observed irrespective of TNF antagonist treatment history. Clinical remission at week 14 may therefore be a predictor for sustained clinical remission with vedolizumab.

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