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Lamichhane N, Melas N, Bergqvist V, Ekholm NP, Olén O, Ludvigsson JF, Hjortswang H, Marsal J, Eriksson C, Halfvarson J. Real-World Outcomes of Patients Starting Intravenous and Transitioning to Subcutaneous Vedolizumab in Inflammatory Bowel Disease. Dig Dis Sci 2024; 69:2175-2183. [PMID: 38637457 PMCID: PMC11162360 DOI: 10.1007/s10620-024-08422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Real-world data on starting intravenous (IV) vedolizumab (VDZ) and transitioning to subcutaneous (SC) treatment in inflammatory bowel disease (IBD) are scarce. AIMS To assess treatment outcomes of patients with IBD starting IV VDZ and switching to SC VDZ in routine clinical care. METHODS Adult patients with IBD switching from IV to SC VDZ treatment between 1 March 2020 and 31 December 2021 were identified from the Swedish IBD quality register. The primary outcome was SC VDZ persistence. Secondary outcomes included clinical remission, changes in quality of life (QoL) according to EuroQual 5-Dimensions 5-Levels (EQ-5D-5L) and the Short-Health Scale (SHS) and inflammatory markers, including faecal Calprotectin (FCP). RESULTS Altogether, 406 patients with IBD (Crohn's disease, n = 181; ulcerative colitis, n = 225) were identified. After a median follow-up of 30 months from starting IV VDZ treatment, the persistence rates were 98%(178/181) in Crohn's disease and 94% (211/225) in ulcerative colitis. Most patients (84%) transitioned during maintenance therapy, and the median follow-up from switch to SC VDZ was 10 months. Compared to baseline, statistically significant improvements were observed in all domains of the SHS, EQ-5D index value and visual analogue scale. Median (interquartile range) FCP concentrations (μg/g) decreased from 459 (185-1001) to 65 (26-227) in Crohn's disease (n = 45; p < 0.001) and from 646 (152-1450) to 49 (20-275) in ulcerative colitis (n = 58; p < 0.001). CONCLUSION Initiating IV VDZ and switching to SC treatment was associated with high persistence rates and improvements in measures of QoL and FCP. These findings are reassuring for patients who start IV VDZ and switch to SC VDZ.
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Affiliation(s)
- N Lamichhane
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Melas
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Central Hospital in Karlstad, Karlstad, Sweden
| | - V Bergqvist
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - N-P Ekholm
- Takeda Pharma, Medical Affairs, Stockholm, Sweden
| | - O Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Stockholm South General Hospital, Sachs' Children and Youth Hospital, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J F Ludvigsson
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Hjortswang
- Department of Gastroenterology and Hepatology in Linköping, Linköping University, Linköping, Sweden
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - J Marsal
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - C Eriksson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - J Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
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Huang K, Yao L, Liu J, Cao Q. Take vedolizumab home: transition from intravenous to subcutaneous treatment. Ther Adv Chronic Dis 2024; 15:20406223241247648. [PMID: 38726235 PMCID: PMC11080802 DOI: 10.1177/20406223241247648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
In 2020, the European Medicines Agency approved subcutaneous (SC) vedolizumab (VDZ) for the maintenance treatment of adult patients with moderate to severe inflammatory bowel disease (IBD). This article reviews the efficacy, safety, persistence, pharmacology, patient satisfaction, and economic implications of transitioning to SC VDZ treatment and explores whether SC formulations can be recommended by the same guidelines as intravenous (IV) formulations. Clinical trials and real-world evidence indicate that transitioning from IV to SC VDZ in patients with IBD maintains clinical, biochemical, and patient-reported clinical remission and is well-tolerated, with no new safety issues identified, except for injection site reactions. Moreover, SC VDZ has an exposure-response relationship and low immunogenicity, is economical, and provides a high level of patient satisfaction. Owing to these advantages, transitioning may be advisable. In the future, more studies are needed to clarify the exact role of SC VDZ in IBD treatment, including optimization and transitioning strategies and individualized treatments based on baseline characteristics.
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Affiliation(s)
- Kaituo Huang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Inflammatory Bowel Disease Center of Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lingya Yao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Inflammatory Bowel Disease Center of Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Liu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Inflammatory Bowel Disease Center of Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, 3 East Qingchun Road, Shangcheng District, Hangzhou 310016, China
- Inflammatory Bowel Disease Center of Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Amor Costa C, Suárez Ferrer C, García Ramírez L, Martín-Arranz E, Poza Cordón J, Rueda García JL, Sánchez Azofra M, González Diaz I, Amiama Roig C, Martín-Arranz MD. Evaluation of the transition from intravenous to subcutaneous vedolizumab in patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00159-6. [PMID: 38723766 DOI: 10.1016/j.gastrohep.2024.502201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/24/2024] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
AIMS The aim of the study is to evaluate the clinical and biochemical response of inflammatory bowel disease patients treated with vedolizumab, 16 weeks after transitioning from intravenous (iv) to subcutaneous (sc). METHODS An observational, prospective, single-center cohort study was performed. Patients with inflammatory bowel disease and maintenance treatment with vedolizumab, stable for at least 4 months, were offered to switch to sc formulation. At the same time of treatment administration a blood test was performed, with vedolizumab levels and fecal calprotectin. RESULTS Forty-three patients were included, 12 of them (27.9%) chose to transition to sc formulation. All included patients remained in remission during follow-up. At week 16 no significant differences were found in terms of calprotectin levels in patients on iv treatment (mean 146.6±SD 45.9) vs. sc (159.26±53.9) (p=0.9). Vedolizumab serum levels at week 16 were higher in the sc group (22,364.3±5141.6) vs. iv (11,425.9±1514.2) (p=0.009). At week 16, 9 (75%) of the patients in the sc group were highly satisfied with the medication and 11 (91.7%) considered it easy to administer. Four patients (12.9%) in the iv group and 2 (16.6%) in the sc group presented mild adverse effects. The 2 cases (100%) of the sc group the adverse event was local inflammation at the injection site. CONCLUSION In our experience, vedolizumab sc is a convenient alternative to iv administration. Vedolizumab serum levels in patients who transitioned to sc were higher than iv formulation.
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Affiliation(s)
- Carmen Amor Costa
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España.
| | - Cristina Suárez Ferrer
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - Laura García Ramírez
- Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - Eduardo Martín-Arranz
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - Joaquín Poza Cordón
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - José Luis Rueda García
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - María Sánchez Azofra
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España
| | - Irene González Diaz
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Clara Amiama Roig
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - María Dolores Martín-Arranz
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario La Paz-IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
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Rajab F, Mujahid A, Rajab H, Alvi A. Letter to the Editor: Switching from vedolizumab intravenous to subcutaneous formulation in ulcerative colitis patients in clinical remission: The SVEDO Study, an IG-IBD study. Dig Liver Dis 2024; 56:716-717. [PMID: 38311530 DOI: 10.1016/j.dld.2024.01.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Fatima Rajab
- King Edward Medical University, Lahore, Pakistan.
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