Clinical and endoscopic recurrence are common after surgery in Crohn’s disease.
Vedolizumab has been increasingly used to treat Crohn’s disease, however, its effectiveness in preventing postoperative recurrence remains unknown.
Dr Atsushi Sakuraba and colleagues from Chicago, USA investigated the use of vedolizumab in the postoperative setting, and compared the risk of recurrence between patients receiving vedolizumab and anti-tumor necrosis factor-α agents.
Medical records of Crohn’s disease patients who underwent surgery between 2014 and 2016 were reviewed.
The research team first analyzed how frequently vedolizumab is used to prevent postoperative recurrence and compared the patient characteristics with those being treated with other therapies.
Furthermore, the rates of endoscopic remission, defined as a simple endoscopic score for Crohn’s disease of 0, at 6–12 months after surgery were compared between patients receiving vedolizumab and anti-tumor necrosis factor-α agents.
Clinical, biological, and histologic outcomes such as Harvey-Bradshaw index, C-reactive protein, and histologic inflammation also were compared between the 2 groups.
Among 203 patients that underwent a Crohn’s disease related surgery, 22 patients received vedolizumab as postoperative treatment.
|Rate of endoscopic remission at 6–12 months in the vedolizumab group was
|Inflammatory Bowel Diseases
There were 58, 38, and 16 patients who received anti-tumor necrosis factor-α agents, immunomodulators, and metronidazole, respectively, whereas 69 patients were monitored without any medication.
The team noted that patients receiving vedolizumab were young and frequently had perianal disease.
Patients postoperatively treated with vedolizumab or anti-tumor necrosis factor-α agents were mostly treated with the same agent pre- and postoperatively.
The team found that the rate of endoscopic remission at 6–12 months in the vedolizumab group was 25%, which was significantly lower as compared to anti-tumor necrosis factor-α agent group.
Vedolizumab use was the only factor that was associated with an increased risk of endoscopic recurrence on both univariate and multivariate analysis.
The results were supported by a propensity score-matched analysis demonstrating lower rates of endoscopic remission in patients treated with vedolizumab as compared to anti-tumor necrosis factor-α agents.
Dr Sakuraba's team concluded, "In the present retrospective cohort study of real-world experience, vedolizumab was shown to be commonly used as postoperative treatment for Crohn’s disease especially in high risk patients."
"Multivariate and propensity score-matched analyses showed that postoperative endoscopic recurrence in Crohn’s disease was higher with vedolizumab than with anti-tumor necrosis factor-α agents, but further investigation including controlled trials is required before determining the utility of vedolizumab in preventing postoperative recurrence of Crohn’s disease."