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• W2912264227 abstract "Introduction: Over the last few years the use of vedolizumab for inflammatory bowel disease (IBD) has increased, particularly for individuals who have previously failed an anti-tumor necrosis factor (anti-TNF) agent. However, there is little data for how these individuals should be managed after subsequent vedolizumab failure. We aim to characterize a single-center experience with the management of vedolizumab treatment failure in biologic-experienced patients with IBD. Methods: We performed a retrospective case-series of IBD patients who received vedolizumab from 5/2014-8/2016. The primary objective was to characterize the current practice with biologic-experienced patients who fail vedolizumab. Secondarily, we compared the effectiveness of post-vedolizumab surgical and medical therapy. All continuous variables were analyzed using Student's t-test or Kruskall-Wallis test and categorical variables were analyzed using chi squared or Fisher's exact test. Analyses were performed using STATA v14.0 (College Station, TX). Results: 52 (34.9%) anti-TNF experienced patients who failed vedolizumab therapy were identified. Of those failures, 10 (19.2%) were managed surgically, 31 (59.6%) received subsequent medical therapy and 11 (21.2%) received combination medical and surgical therapy. Post-surgical clinical remission was 40.0% as compared to 6.5% in the medical arm, and 9.1% in the combination arm (Figure 1). Surgery was more strongly associated with clinical remission after vedolizumab failure (OR 9.7, 95% CI 1.4-65.4) than medical therapy. Surgery (OR 31.5, 95% CI 1.07-923.86, p=0.046) remained a strong predictor of clinical remission when controlling for duration of IBD, along with the number of prior biologic failures, and type of IBD. A subgroup analysis by type of IBD, revealed that Crohn's disease patients accounted for a majority of the difference in clinical remission.Figure: Clinical remission rates for post-vedolizumab treatment options by type of inflammatory bowel disease.Conclusion: With the advent of new biologics and other novel agents for the management of IBD, it has become increasingly unclear when to proceed with further medical therapy and when to pursue surgical therapy for refractory disease. Though exploratory, we found surgical therapy to be associated with higher clinical remission rates compared to medical therapy after vedolizumab failure in anti-TNF experienced patients. Larger multicenter studies working towards creation and validation of a treatment algorithm for these complex IBD patients are necessary." @default.
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• W2912264227 date "2017-10-01" @default.
• W2912264227 modified "2023-10-18" @default.
• W2912264227 title "Treatment Algorithm for Inflammatory Bowel Disease Patients Who Fail Vedolizumab as Salvage Therapy" @default.
• W2912264227 doi "https://doi.org/10.14309/00000434-201710001-02726" @default.
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