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Alamer A, Al Lehaibi LH, Alomar M, Aldhuwayan F, Alshouish S, Al-Ali AY, Almudhry Z, Almulhim A, Althagafi A, Aldosari S, AlAmeel T. Short term effectiveness of ustekinumab versus vedolizumab in Crohn's disease after failure of anti-TNF agents: An observational comparative study design with a Bayesian analysis. Saudi J Gastroenterol 2024; 30:324-334. [PMID: 39157885 DOI: 10.4103/sjg.sjg_101_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Crohn's disease (CD) is a debilitating gastrointestinal disease with complex etiology. Although effective, recipients of anti-tumor necrosis factor (TNF) agents may experience primary or secondary nonresponse, necessitating alternative treatments. This study is intended to compare the short-term effectiveness of ustekinumab and vedolizumab in treating CD after failure of multiple lines of anti-TNF therapy using real-world data. METHODS A retrospective study was conducted at a tertiary hospital in Dammam, Saudi Arabia, including adults (≥18 years old) with CD who did not respond to anti-TNF therapy. Primary endpoints were clinical improvement per the Harvey-Bradshaw Index (HBI) scores and remission at 12 weeks on an ordinal outcome scale. Secondary endpoints included clinical, biochemical, and endoscopic remission; clinical response; corticosteroid-free days; and cumulative steroid dose. Proportional odds and logistic regression Bayesian models were used to analyze outcomes, and the probability of treatment effectiveness was calculated from the posterior distribution. RESULTS The study included 101 patients (ustekinumab, n = 71 and vedolizumab, n = 30) with a median age of 32 years (IQR: 26.0-38.0); 54.4% were male. At 12 weeks, the HBI endpoint showed an adjusted odds ratio (aOR) = 0.60 (95% confidence interval [CI]: 0.25-1.31), favoring ustekinumab, with a 75% probability of treatment effectiveness over vedolizumab. The clinical ordinal scale had an aOR = 0.61 (95% CI: 0.26-1.35) with a 73% probability of effectiveness for ustekinumab. Ustekinumab was also associated with favorable outcomes in secondary endpoints, reaching up to a 90% probability of effectiveness. CONCLUSION In CD patients with anti-TNF failure, ustekinumab was more effective than vedolizumab in the short term. These real-world insights contribute to understanding CD management but require validation in larger prospective studies and randomized controlled trials.
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Affiliation(s)
- Ahmad Alamer
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Lina H Al Lehaibi
- Pharmaceutical Affairs, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Mukhtar Alomar
- Pharmaceutical Affairs, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Fahad Aldhuwayan
- Pharmaceutical Affairs, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Saleh Alshouish
- Pharmaceutical Affairs, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Anfal Y Al-Ali
- Pharmaceutical Affairs, Dhahran Eye Specialist Hospital, Eastern Health Cluster, Dhahran, Saudi Arabia
| | - Zakia Almudhry
- Department of Medicine, Eastern Health Cluster, Dammam Medical Complex, Dammam, Saudi Arabia
| | - Abdulaziz Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdulhamid Althagafi
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saad Aldosari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Turki AlAmeel
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Hyun HK, Zhang HS, Yu J, Kang EA, Park J, Park SJ, Park JJ, Kim TI, Kim WH, Cheon JH. Comparative effectiveness of second-line biological therapies for ulcerative colitis and Crohn’s disease in patients with prior failure of anti-tumour necrosis factor treatment. BMC Gastroenterol 2022; 22:143. [PMID: 35346063 PMCID: PMC8958783 DOI: 10.1186/s12876-022-02225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Therapeutic options for inflammatory bowel disease (IBD) have increased since the introduction of tumour necrosis factor (TNF) inhibitors a few decades ago. However, direct comparisons of the effectiveness of second-line biological agents in patients with ulcerative colitis (UC) and Crohn’s disease (CD) are lacking.
Methods
Patients with UC or CD who experienced anti-TNF treatment failure and subsequently used vedolizumab, ustekinumab, or tofacitinib as a second-line drug were retrospectively recruited. The primary outcomes were the clinical remission rate at week 16 and the cumulative relapse rate 48 weeks after receiving induction therapy.
Results
A total of 94 patients with UC or CD experienced anti-TNF treatment failure and received vedolizumab (UC: 37; CD: 28), ustekinumab (CD: 16), or tofacitinib (UC: 13). The clinical remission rates were not significantly different between the vedolizumab and tofacitinib groups in UC patients (56.8% vs. 46.2%, p = 0.509). In CD patients, the clinical remission rates were not significantly different between the vedolizumab and ustekinumab groups (53.6% vs. 50.0%, p = 0.820). Moreover, the cumulative rates of clinical relapse were not significantly different between the vedolizumab and tofacitinib groups in UC patients and between the vedolizumab and ustekinumab groups in CD patients (p = 0.396 and p = 0.692, respectively). Safety profiles were also similar among the treatment groups in both UC and CD patients.
Conclusions
After prior anti-TNF therapy failure, vedolizumab and tofacitinib in UC patients and vedolizumab and ustekinumab in CD patients were not significantly different in terms of the efficacy in inducing and maintaining a clinical response.
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Scott FI, Luo M, Shah Y, Lasch K, Vajravelu RK, Mamtani R, Fennimore B, Gerich ME, Lewis JD. Identification of the Most Cost-effective Position of Vedolizumab Among the Available Biologic Drugs for the Treatment of Ulcerative Colitis. J Crohns Colitis 2020; 14:575-587. [PMID: 31901085 PMCID: PMC7303595 DOI: 10.1093/ecco-jcc/jjz212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS There are limited data on the most cost-effective sequencing of biologics for ulcerative colitis [UC]. METHODS We used Markov modelling to identify the most cost-effective position for vedolizumab among biologics for steroid-dependent UC, with a base-case of a 35-year-old male. We assessed three treatment algorithms, with vedolizumab use: prior to an initial anti-tumour necrosis factor alpha [anti-TNFα] and azathioprine [Algorithm 1]; prior to a second anti-TNF and azathioprine [Algorithm 2]; and prior to colectomy [Algorithm 3]. The initial anti-TNF could be either infliximab or adalimumab. Transition probabilities, costs, and quality-adjusted life-year estimates were derived from published estimates, Medicare, and the Nationwide Inpatient Sample. Primary analyses included 100 trials of 100 000 individuals over 1 year, with a willingness-to-pay threshold of US$100,000. Multiple sensitivity analyses were conducted to assess our findings. RESULTS From a population perspective, when both infliximab and adalimumab are available, vedolizumab was preferred as the first biologic if ≥14% of initial anti-TNF use was adalimumab. If infliximab is the primary biologic, vedolizumab use after infliximab [Algorithm 2] and prior to adalimumab was the most cost-effective strategy. All models were sensitive to biologic pricing. CONCLUSIONS This simulation demonstrated that the most cost-effective strategy in UC depends on the proportion of patients using adalimumab as the initial anti-TNF. If adalimumab was ≥14%, vedolizumab was preferred as the first biologic. When only infliximab was available for first-line therapy, the most cost-effective position of vedolizumab was prior to cycling to adalimumab.
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Affiliation(s)
- Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO,USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Corresponding author: Frank I. Scott, MD, MSCE, Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA. Tel.: 720-848-2777; fax: 720-848-2778;
| | - Michelle Luo
- University of Pennsylvania School of Arts and Sciences, Philadelphia PA, USA
| | - Yash Shah
- Global Evidence & Out, Takeda Pharmaceuticals, Deerfield, IL, USA
| | - Karen Lasch
- US Medical Department, Takeda Pharmaceuticals, Deerfield, IL, USA
| | - Ravy K Vajravelu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronac Mamtani
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Blair Fennimore
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO,USA
| | - Mark E Gerich
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO,USA
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,US Medical Department, Takeda Pharmaceuticals, Deerfield, IL, USA
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4
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Gemayel NC, Rizzello E, Atanasov P, Wirth D, Borsi A. Dose escalation and switching of biologics in ulcerative colitis: a systematic literature review in real-world evidence. Curr Med Res Opin 2019; 35:1911-1923. [PMID: 31192706 DOI: 10.1080/03007995.2019.1631058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Biologics used to treat ulcerative colitis (UC) may lose their effect over time, requiring patients to undergo dose escalation or treatment switching, and systematic literature reviews of real-world evidence on these topics are lacking. Aim: To summarize the occurrence and outcomes of dose escalation and treatment switching in UC patients in real-world evidence. Methods: Studies were searched through MEDLINE, MEDLINE IN PROCESS, Embase and Cochrane (2006-2017) as well as proceedings from three major scientific meetings. Results: In total, 41 studies were included in the review among which 35 covered dose escalation and 12 covered treatment switching of biologics. Tumor necrosis factor antagonist (anti-TNF) escalation for all patients included at induction ranged from 5% (6 months) to 50% (median 0.67 years) and 15.2% to 70.8% (8 weeks) for anti-TNF induction responders. Mean/median time to dose escalation on anti-TNF ranged from 1.84 to 11 months. The most common switching pattern, infliximab → adalimumab, occurred in 3.8% (median 5.6 years) to 25.5% (mean 3.3 years) of patients. Conclusions: Dose escalation and treatment switching of biologics may be considered as indicators of suboptimal therapy suggesting a lack of long-term remission and response under current therapies.
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Affiliation(s)
- Nathalie C Gemayel
- Health Economics & Market Access (HEMA), Amaris Consulting Ltd , Barcelona , Spain
| | - Eugenio Rizzello
- Health Economics & Market Access (HEMA), Amaris Consulting Ltd , London , UK
| | - Petar Atanasov
- Health Economics & Market Access (HEMA), Amaris Consulting Ltd , Barcelona , Spain
| | - Daniel Wirth
- Market Access, Janssen-Cilag GmbH , Neuss , Germany
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Dulai PS, Buckey JC, Raffals LE, Swoger JM, Claus PL, OʼToole K, Ptak JA, Gleeson MW, Widjaja CE, Chang JT, Adler JM, Patel N, Skinner LA, Haren SP, Goldby-Reffner K, Thompson KD, Siegel CA. Hyperbaric oxygen therapy is well tolerated and effective for ulcerative colitis patients hospitalized for moderate-severe flares: a phase 2A pilot multi-center, randomized, double-blind, sham-controlled trial. Am J Gastroenterol 2018; 113:1516-1523. [PMID: 29453383 DOI: 10.1038/s41395-018-0005-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hyperbaric oxygen therapy (HBOT) markedly increases tissue oxygen delivery. Case series suggest it may have a potential therapeutic benefit in ulcerative colitis (UC). We investigated the therapeutic potential of HBOT as an adjunct to steroids for UC flares requiring hospitalization. METHODS The study was terminated early due to poor recruitment with 18 of the planned 70 patients enrolled. UC patients hospitalized for moderate-severe flares (Mayo score ≥6, endoscopic sub-score ≥2) were block randomized to steroids + daily HBOT (n = 10) or steroids + daily sham hyperbaric air (n = 8). Patients were blinded to study assignment, and assessments were performed by a blinded gastroenterologist. Primary outcome was the clinical remission rate at study day 5 (partial Mayo score ≤2 with no sub-score >1). Key secondary outcomes were: clinical response (reduction in partial Mayo score ≥2, rectal bleeding sub-score of 0-1) and progression to second-line therapy (colectomy or biologic therapy) during the hospitalization. RESULTS A significantly higher proportion of HBOT-treated patients achieved clinical remission at study day 5 and 10 (50 vs. 0%, p = 0.04). HBOT-treated patients less often required progression to second-line therapy during the hospitalization (10 vs. 63%, p = 0.04). The proportion requiring in-hospital colectomy specifically as second-line therapy for medically refractory UC was lower in the HBOT group compared to sham (0 vs. 38%, p = 0.07). There were no serious adverse events. CONCLUSION In this small, proof-of-concept, phase 2A trial, the use of HBOT as an adjunctive therapy to steroids for UC patients hospitalized for moderate-severe flares resulted in higher rates of clinical remission, and a reduction in rates of progression to second-line therapy during the hospitalization. Larger well-powered trials are needed, however, to provided definitive evidence of therapeutic benefit.
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Affiliation(s)
- Parambir S Dulai
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jay C Buckey
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura E Raffals
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jason M Swoger
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul L Claus
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin OʼToole
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Judy A Ptak
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael W Gleeson
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christella E Widjaja
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John T Chang
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffery M Adler
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nihal Patel
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laurie A Skinner
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shawn P Haren
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Goldby-Reffner
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly D Thompson
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Corey A Siegel
- University of California at San Diego, La Jolla, CA, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Rosario M, Dirks NL, Milch C, Parikh A, Bargfrede M, Wyant T, Fedyk E, Fox I. A Review of the Clinical Pharmacokinetics, Pharmacodynamics, and Immunogenicity of Vedolizumab. Clin Pharmacokinet 2018; 56:1287-1301. [PMID: 28523450 PMCID: PMC5648740 DOI: 10.1007/s40262-017-0546-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vedolizumab is a humanized anti-α4β7 integrin monoclonal antibody that selectively blocks trafficking of memory T cells to inflamed gut tissue by inhibiting the α4β7-mucosal addressin cell adhesion molecule-1 (MAdCAM-1) interaction. Approved for treating patients with moderately to severely active ulcerative colitis (UC) or Crohn’s disease (CD), vedolizumab is administered as a 300 mg intravenous infusion. Vedolizumab undergoes a rapid, saturable, non-linear, target-mediated elimination process at low concentrations and a slower, linear, non-specific elimination process at higher concentrations. At therapeutic concentrations, vedolizumab primarily undergoes linear elimination. From population pharmacokinetic modeling, the vedolizumab terminal elimination half-life (t½β) was estimated to be 25.5 days; linear clearance (CLL) was similar for patients with UC (0.159 L/day) and CD (0.155 L/day). Extreme low albumin concentrations and extreme high body weight values were potentially clinically important predictors of vedolizumab CLL. Other factors, including concomitant therapy use (methotrexate, azathioprine, mercaptopurine, or aminosalicylates) or prior tumor necrosis factor-α (TNF-α) antagonist use, had no clinically relevant effects on CLL. A positive exposure–efficacy relationship for clinical remission and clinical response was apparent for vedolizumab induction therapy in patients with UC or CD. On average, patients with higher albumin, lower fecal calprotectin (UC only), lower C-reactive protein (CD only), and no prior TNF-α antagonist use had a higher probability of remission. Off drug, 10% of patients with UC or CD were positive for anti-drug antibodies. This article provides a comprehensive review of the clinical pharmacokinetics, pharmacodynamics, exposure–efficacy relationships, and immunogenicity of vedolizumab.
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MESH Headings
- Antibodies, Monoclonal, Humanized/blood
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/pharmacology
- Colitis, Ulcerative/blood
- Colitis, Ulcerative/drug therapy
- Crohn Disease/blood
- Crohn Disease/drug therapy
- Drug Interactions
- Gastrointestinal Agents/blood
- Gastrointestinal Agents/immunology
- Gastrointestinal Agents/pharmacokinetics
- Gastrointestinal Agents/pharmacology
- Humans
- Remission Induction
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Affiliation(s)
- Maria Rosario
- Takeda Development Center Americas, Inc., Cambridge, MA, USA.
| | | | - Catherine Milch
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Asit Parikh
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | | | - Eric Fedyk
- Takeda Pharmaceuticals International Inc., Deerfield, IL, USA
| | - Irving Fox
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
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7
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Scott FI, Shah Y, Lasch K, Luo M, Lewis JD. Assessing the Optimal Position for Vedolizumab in the Treatment of Ulcerative Colitis: A Simulation Model. Inflamm Bowel Dis 2018; 24:286-295. [PMID: 29361100 DOI: 10.1093/ibd/izx045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vedolizumab, an α4β7 integrin monoclonal antibody inhibiting gut lymphocyte trafficking, is an effective treatment for ulcerative colitis (UC). We evaluated the optimal position of vedolizumab in the UC treatment paradigm. METHODS Using Markov modeling, we assessed multiple algorithms for the treatment of UC. The base case was a 35-year-old male with steroid-dependent moderately to severely active UC without previous immunomodulator or biologic use. The model included 4 different algorithms over 1 year, with vedolizumab use prior to: initiating azathioprine (Algorithm 1), combination therapy with infliximab and azathioprine (Algorithm 2), combination therapy with an alternative anti-tumor necrosis factor (anti-TNF) and azathioprine (Algorithm 3), and colectomy (Algorithm 4). Transition probabilities and quality-adjusted life-year (QALY) estimates were derived from the published literature. Primary analyses included simulating 100 trials of 100,000 individuals, assessing clinical outcomes, and QALYs. Sensitivity analyses employed longer time horizons and ranges for all variables. RESULTS Algorithm 1 (vedolizumab use prior to all other therapies) was the preferred strategy, resulting in 8981 additional individuals in remission, 18 fewer cases of lymphoma, and 1087 fewer serious infections per 100,000 patients compared with last-line use (A4). Algorithm 1 also resulted in 0.0197 to 0.0205 more QALYs compared with other algorithms. This benefit increased with longer time horizons. Algorithm 1 was preferred in all sensitivity analyses. CONCLUSION The model suggests that treatment algorithms positioning vedolizumab prior to other therapies should be considered for individuals with moderately to severely active steroid-dependent UC. Further prospective research is needed to confirm these simulated results.
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Affiliation(s)
- Frank I Scott
- Division of Gastroenterology, Department of Medicine, University of Colorado Denver, Aurora, Colorado.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yash Shah
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Lasch
- US Medical Office, Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois
| | - Michelle Luo
- Health Economics and Outcomes Research, Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois
| | - James D Lewis
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,University of Pennsylvania, Philadelphia, Pennsylvania
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Allegretti JR, Barnes EL, Stevens B, Storm M, Ananthakrishnan A, Yajnik V, Korzenik J. Predictors of Clinical Response and Remission at 1 Year Among a Multicenter Cohort of Patients with Inflammatory Bowel Disease Treated with Vedolizumab. Dig Dis Sci 2017; 62:1590-1596. [PMID: 28357697 PMCID: PMC5661939 DOI: 10.1007/s10620-017-4549-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vedolizumab (VDZ) has demonstrated long-term efficacy in Crohn's disease (CD) and ulcerative colitis (UC) in phase III trials. AIMS Our aim was to evaluate the efficacy of VDZ at week 54 in inflammatory bowel disease (IBD) in a multicenter cohort of patients. METHODS Adult patients completing induction therapy with VDZ were eligible for this study. Clinical response and remission was assessed using the Harvey-Bradshaw Index (HBI) for CD, the Simple Clinical Colitis Activity Index for UC and physician assessment. RESULTS Among 136 total patients (96 CD and 40 UC), 76 (56%) demonstrated clinical response or remission at week 54. In univariate analysis, for patients with CD concomitant initiation of immunomodulator therapy (2.71, 95% CI 1.11-6.57), the addition of an immunomodulator (OR 11.49, 3.16-41.75) and CRP < 3 (4.92, 95% CI 1.99-12.15) was associated with increased odds of clinical response or remission at week 54. For UC patients, hospitalization after VDZ induction was associated with decreased odds of response or remission at week 54 (OR 0.22, 95% CI 0.05-0.88). On multivariate analysis in CD, addition of an immunomodulator (OR 8.33, 95% CI 2.15-32.26) remained significant predictors of clinical response or remission at week 54. CONCLUSIONS Among a multicenter cohort of patients with IBD demonstrating primary response to VDZ, the addition of combination therapy with an immunomodulator is a significant predictor of clinical response or remission at week 54 in patients with CD.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02141, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Edward L Barnes
- Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02141, USA
- Harvard Medical School, Boston, MA, USA
| | - Betsey Stevens
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret Storm
- Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02141, USA
| | - Ashwin Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Vijay Yajnik
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joshua Korzenik
- Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02141, USA
- Harvard Medical School, Boston, MA, USA
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9
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Abstract
A substantial proportion of patients with ulcerative colitis (UC) have failed conventional therapies such as steroids, immunosuppressants or TNF-antibodies, or have experienced side effects. This article reviews the pharmacological properties of vedolizumab (VDZ), its efficacy and side effects in UC. By its relatively specific gut-selective mode of action, VDZ's safety profile appears more favorable than that of anti-TNF therapies. VDZ is more effective than placebo for the induction and maintenance of remission in moderate-to-severe UC in both naïve patients and patients who have failed anti-TNF treatment. However, in some patients, VDZ has a slower onset of action. But, to place VDZ as a first-line therapy, it must go head-to-head with azathioprine and anti-TNF antibodies in future studies.
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Affiliation(s)
- Andreas Stallmach
- a Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases) , University Hospital Jena , Jena , Germany
| | - Carsten Schmidt
- a Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases) , University Hospital Jena , Jena , Germany
| | - Niels Teich
- b Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten , Leipzig , Germany
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Romero-Castro A, Gutiérrez-Sánchez M, Correa-Basurto J, Rosales Hernández MC, Padilla Martínez II, Mendieta-Wejebe JE. Pharmacokinetics in Wistar Rats of 5-[(4-Carboxybutanoyl)Amino]-2-Hydroxybenzoic Acid: A Novel Synthetic Derivative of 5-Aminosalicylic Acid (5-ASA) with Possible Anti-Inflammatory Activity. PLoS One 2016; 11:e0159889. [PMID: 27454774 PMCID: PMC4959752 DOI: 10.1371/journal.pone.0159889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022] Open
Abstract
5-[(4-carboxybutanoyl)amino]-2-hydroxybenzoic acid (C2) is a novel synthetic derivative of 5-aminosalicylic acid (5-ASA), which is currently being evaluated ex vivo as an anti-inflammatory agent and has shown satisfactory results. This study aimed to obtain the pharmacokinetic profiles, tissue distribution and plasma protein binding of C2 in Wistar Rats. Additionally, an HPLC method was developed and validated to quantify C2 in rat plasma. The pharmacokinetic profiles of intragastric, intravenous and intraperitoneal administration routes at singles doses of 100, 50, and 100 mg/kg, respectively, were studied in Wistar rats. The elimination half-life of intravenously administered C2 was approximately 33 min. The maximum plasma level of C2 was reached approximately 24 min after intragastric administration, with a Cmax value of 2.5 g/mL and an AUCtot value of 157 μg min-1/mL; the oral bioavailability was approximately 13%. Following a single intragastric or oral dose (100 mg/kg), C2 was distributed and detected in all examined tissues (including the brain and colon). The results showed that C2 accumulates over time. The plasma protein binding results indicated that the unbound fraction of C2 at concentrations of 1 to 20 μg/mL ranged from 89.8% to 92.5%, meaning that this fraction of C2 is available to cross tissues. Finally, the blood-plasma partitioning (BP ratio) of C2 in rat plasma was 0.71 and 0.6 at concentrations of 5 and 10 μg/mL, respectively, which indicates that C2 is free in the plasmatic phase and not inside blood cells. The results of this study suggest that a fraction of the administered C2 dose is absorbed in the stomach, and the fraction that is not absorbed reaches the small intestine and colon. This distribution constitutes the main advantage of C2 compared with 5-ASA for the treatment of ulcerative colitis (UC) and Crohn's disease (CD).
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Affiliation(s)
- Aurelio Romero-Castro
- Laboratorio de Biofísica y Biocatálisis, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Salvador Díaz Mirón s/n, Casco de Santo Tomás, Ciudad de México 11340, México
| | - Mara Gutiérrez-Sánchez
- Laboratorio de Biofísica y Biocatálisis, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Salvador Díaz Mirón s/n, Casco de Santo Tomás, Ciudad de México 11340, México
| | - José Correa-Basurto
- Laboratorio de Modelado Molecular y Bioinformática, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Salvador Díaz Mirón s/n, Casco de Santo Tomás, Ciudad de México 11340, México
| | - Martha Cecilia Rosales Hernández
- Laboratorio de Biofísica y Biocatálisis, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Salvador Díaz Mirón s/n, Casco de Santo Tomás, Ciudad de México 11340, México
| | - Itzia Irene Padilla Martínez
- Laboratorio de Química Supramolecular y Orgánica, Departamento de Ciencias Básicas, Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Av. Acueducto s/n, Barrio La Laguna Ticomán, Ciudad de México 07340, México
| | - Jessica Elena Mendieta-Wejebe
- Laboratorio de Biofísica y Biocatálisis, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Salvador Díaz Mirón s/n, Casco de Santo Tomás, Ciudad de México 11340, México
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Dulai PS, Singh S, Vande Casteele N, Boland BS, Sandborn WJ. How Will Evolving Future Therapies and Strategies Change How We Position the Use of Biologics in Moderate to Severely Active Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:998-1009. [PMID: 26835982 PMCID: PMC5953904 DOI: 10.1097/mib.0000000000000661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several biological agents have been added to our armamentarium of treatment options for moderate to severely active inflammatory bowel diseases, and this number is expected to only increase in the near future. With our growing understanding of disease mechanisms and pharmacokinetics, we are now able to target several mechanisms of action to achieve key endpoints (steroid-free remission and mucosal healing) associated with improved long-term disease-related outcomes. In this context, concerns arise regarding the optimal positioning of currently available biologics and key biologics in development. In this review, we will discuss the currently available evidence for comparative effectiveness of biological agents approved for the use in moderate to severely active inflammatory bowel diseases, with a focus on practical considerations to be made when using these agents in practice. We will further review novel biological agents and small molecule inhibitors in development and discuss future opportunities through which providers may personalize treatment decisions to achieve optimal treatment outcomes.
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Affiliation(s)
- Parambir S. Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, CA
- Robarts Clinical Trials, Robarts Research Institute, La Jolla, CA
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, CA
| | - Niels Vande Casteele
- Division of Gastroenterology, University of California San Diego, La Jolla, CA
- Robarts Clinical Trials, Robarts Research Institute, La Jolla, CA
- Department of Pharmaceutical and Pharmacological Sciences, KU Leven – University of Leuven, Leuven, Belgium
| | - Brigid S. Boland
- Division of Gastroenterology, University of California San Diego, La Jolla, CA
| | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA
- Robarts Clinical Trials, Robarts Research Institute, La Jolla, CA
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Vedolizumab for the Treatment of Moderately to Severely Active Ulcerative Colitis. Pharmacotherapy 2015; 35:979. [DOI: 10.1002/phar.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hagan M, Cross RK. Safety of vedolizumab in the treatment of Crohn's disease and ulcerative colitis. Expert Opin Drug Saf 2015; 14:1473-9. [PMID: 26138111 DOI: 10.1517/14740338.2015.1063612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Vedolizumab is the latest FDA-approved anti-integrin therapy for treatment of moderate-to-severe inflammatory bowel disease (IBD). The safety and efficacy of vedolizumab have been studied in short-term clinical trials. AREAS COVERED This paper reviews the safety profile of vedolizumab compared with other biologics. It also highlights the mechanism of action of the medication. We discuss the current position of vedolizumab in our current algorithm for IBD management and comment on future prospects of the drug. EXPERT OPINION Vedolizumab appears to be a safe and effective option in the treatment of moderate-to-severe IBD in the short term. Long-term observational studies and post-marketing safety data are needed to ascertain the long-term efficacy and side effect profile.
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Affiliation(s)
- Matilda Hagan
- a 1 University of Maryland, Division of Gastroenterology and Hepatology, Department of Medicine , 100 North Greene Street, Lower Level, Baltimore, MD 21201, USA
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