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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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Harno-Tasihin J, Siregar L, Paajanen M, Arkkila P, Punkkinen J. Switching from intravenous to subcutaneous infliximab and vedolizumab in patients with inflammatory bowel disease: impact on trough levels, day hospital visits, and medical expenses. Scand J Gastroenterol 2024; 59:280-287. [PMID: 38006219 DOI: 10.1080/00365521.2023.2285229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Subcutaneous (SC) infliximab (IFX) and vedolizumab (VDZ) have recently become available. We aimed to examine the impact of switching from intravenous (IV) to SC IFX and VDZ in patients with inflammatory bowel disease (IBD) on costs, the day hospital burden, trough levels, and clinical outcomes. METHODS Our study comprised the cohort of IBD patients receiving IV IFX or VDZ at our hospital in 2022. We evaluated costs, day hospital visits, trough levels, biochemical markers, relapse rates, and self-report outcomes until Jun 30th 2023. RESULTS Of 114 patients, 18 continued IV therapy, 80 were switched to SC therapy, and 16 were inductions. Eighty-eight (90%) remained in steroid-free remission with no difference between the IV or SC groups. The mean IFX trough level changed from 8.2 ± 4.5 µg/ml to 14.5 ± 5.9 µg/ml, p < 0.001, and the VDZ trough level from 14.7 ± 7.1 mg/ml to 26.5 ± 13.8 mg/ml, p < 0.001. The average yearly costs of infusions and injections per patient were 2 580 € and 7 482 € for IFX and 15 990 € and 13 101 € for VDZ. The annual reduction of day hospital visits was 6,9 per patient. CONCLUSIONS IV and SC IFX and VDZ are equally effective in maintaining remission in IBD, but SC administration reduces day hospital visits and results in higher trough levels. SC VDZ is less and SC IFX more expensive than IV therapy. Further studies are needed to assess optimal dosing and separate trough levels for SC therapy.
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Affiliation(s)
| | - Laura Siregar
- Endoscopy Outpatient Clinic, HUS, Hyvinkää Hospital, Hyvinkää, Finland
| | - Mikko Paajanen
- Endoscopy Outpatient Clinic, HUS, Hyvinkää Hospital, Hyvinkää, Finland
| | - Perttu Arkkila
- Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
- Department of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Punkkinen
- Endoscopy Outpatient Clinic, HUS, Hyvinkää Hospital, Hyvinkää, Finland
- Endoscopy Unit, HUS, Jorvi Hospital, Espoo, Finland
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Tursi A, Mocci G, Del Gaudio A, Papa A. Clinical use of biologics for Crohn's disease in adults: lessons learned from real-world studies. Expert Opin Biol Ther 2024:1-19. [PMID: 38321868 DOI: 10.1080/14712598.2024.2316180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The therapeutic armamentarium for managing Crohn's disease (CD) has expanded significantly in recent decades. Several biologics with three different mechanisms of action [anti-tumor necrosis factor (TNF)-α, anti-integrin α4β7, and anti-IL 12/23] are currently available to manage CD. AREA COVERED This narrative review aims to summarize the most significant efficacy and safety data on the use of infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ) and ustekinumab (UST) for the treatment of CD obtained from studies conducted in the real world (RW), compared to the results of randomized clinical trials (RCTs). EXPERT OPINION RW studies reported that biologic agents included in this analysis have higher remission rates and lower adverse event rates than findings from RCTs for treating patients with CD. All biological agents have proven effective and safe in RW studies, even when using biosimilars or switching to subcutaneous administration of the molecules for which they are available. Finally, anti-TNF-α agents, particularly IFX, have a higher rate of adverse events (AEs) than VDZ and UST. Therefore, patients at higher risk of AEs may benefit from other biologics than anti-TNF-α. However, further long-term RW studies are needed to confirm these findings.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy
- Department of Medical and Surgical Sciences, Catholic University, School of Medicine, Rome, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Angelo Del Gaudio
- Division of Internal Medicine and Gastroenterology, Policlinico Universitario "A. Gemelli" IRCCS Foundation, Rome, Italy
| | - Alfredo Papa
- Department of Medical and Surgical Sciences, Catholic University, School of Medicine, Rome, Italy
- Division of Internal Medicine and Gastroenterology, Policlinico Universitario "A. Gemelli" IRCCS Foundation, Rome, Italy
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Pintar Š, Hanžel J, Drobne D, Koželj M, Kurent T, Smrekar N, Novak G. Remission Is Maintained after Switch from Dose-Optimised Intravenous Treatment to Subcutaneous Treatment with Vedolizumab in Inflammatory Bowel Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:296. [PMID: 38399583 PMCID: PMC10890533 DOI: 10.3390/medicina60020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The subcutaneous (SC) formulation of vedolizumab has proven to be effective for the maintenance of remission after intravenous induction. Little is known about the efficacy of switching from intravenous maintenance treatment to SC. We aimed to assess the real-world efficacy of switching to SC treatment and to assess the impact of a baseline treatment regimen. Materials and Methods: In this observational cohort study, adult patients with inflammatory bowel disease who were switched to SC vedolizumab maintenance treatment were enrolled. Patients after intravenous induction and patients who switched from intravenous maintenance treatment (every 8 weeks or every 4 weeks) were included. The SC vedolizumab dosing was 108 mg every 2 weeks, regardless of the previous regimen. The clinical, biochemical, and endoscopic disease activity parameters and vedolizumab serum concentrations at the time of the switch and at the follow-up were assessed. Results: In total, 135 patients (38% Crohn's disease, 62% ulcerative colitis) were switched to SC vedolizumab treatment. The median time to the first follow-up (FU) was 14.5 weeks (IQR 12-26), and the median time to the second FU was 40 weeks (IQR 36-52). Nine patients (7%) discontinued SC vedolizumab treatment, with two-thirds of them discontinuing due to active disease. In all dosing regimens, there were no significant changes in the clinical scores and CRP at the baseline and first and second FUs. Clinical and biochemical remission appeared to be maintained irrespective of the previous dosing regimen. Conclusions: The results of this real-world study suggest that the maintenance of clinical and biomarker remission can be achieved in patients who switched from intravenous to SC vedolizumab. The baseline vedolizumab dosing regimen (every 4 weeks versus every 8 weeks) did not have an impact on outcomes.
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Affiliation(s)
- Špela Pintar
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Matic Koželj
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Nataša Smrekar
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Gregor Novak
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Ribaldone DG, Parisio L, Variola A, Bossa F, Castiglione F, Marzo M, Piazza N, Aratari A, Savarino EV, Bodini G, Mastronardi M, Micheli F, Mazzuoli S, Ascolani M, Viganò C, Cappello M, Bezzio C, Ciccocioppo R, Scardino G, Sarli E, Pugliese D, Scaldaferri F, Napolitano D, Todeschini A, Geccherle A, Colaci N, Guerra M, Annese M, Testa A, Caiazzo A, Conforti FS, Festa S, Lorenzon G, Marra A, Magiotta A, Baccini F, Amato A, Poshnjari A, Vernero M, Caprioli F, Caviglia GP. 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; 56:77-82. [PMID: 37474412 DOI: 10.1016/j.dld.2023.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The administration of biological drugs in inflammatory bowel diseases (IBD) is increasingly moving from intravenous to subcutaneous formulations. AIMS To evaluate the efficacy and safety of vedolizumab subcutaneous administration after switching from intravenous administration in ulcerative colitis (UC) patients in corticosteroid-free clinical remission. METHODS An observational, multicentre, prospective study was conducted by the Italian Group for the study of IBD (IG-IBD). UC patients in clinical remission (pMAYO < 2) not receiving steroids for > 8 months before the switch, and with at least 6 months of follow-up were included. Switch from intravenous to subcutaneous vedolizumab was defined as successful in patients not experiencing a disease flare (pMAYO ≥ 2) or needing oral steroids or stopping subcutaneous vedolizumab during the 6 months of follow-up after the switch. RESULTS Overall, 168 patients were included. The switch was a success in 134 patients (79.8%). Vedolizumab retention rate was 88.7% at month six. C-reactive protein and faecal calprotectin values did not change after the switch (p = 0.07 and p = 0.28, respectively). Ten of the 19 patients who stopped subcutaneous formulation switched back to intravenous formulation recapturing clinical remission in 80%. Side effects were observed in 22 patients (13.1%). CONCLUSION Effectiveness of switching from intravenous to subcutaneous vedolizumab formulation in UC patients in steroid-free clinical remission is confirmed in a real-world setting.
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Affiliation(s)
| | - Laura Parisio
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Angela Variola
- IBD Unit - IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - Manuela Marzo
- UOC Gastroenterologia Ospedale Veris delli Ponti, Scorrano, LE, Italy
| | - Nicole Piazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Federica Micheli
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Endoscopy Unit, Ospedale "DiMiccoli" Barletta (BAT), Italy
| | - Marta Ascolani
- UOC Gastroenterologia, ULSS2 Marca Trevigiana, Ospedale Ca'Foncello, Treviso, Italy
| | - Chiara Viganò
- Department of Gastroenterology, and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Maria Cappello
- UOC Gastroenterologia - AOUP P. Giaccone, Palermo, Italy
| | - Cristina Bezzio
- IBD Center, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, Verona, Italy
| | - Giulia Scardino
- Gastroenterology Department, "Valduce" Hospital, Como, Italy
| | - Ennio Sarli
- Italian Group for the study of Inflammatory Bowel Disease IG-IBD, Florence, Italy
| | - Daniela Pugliese
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Franco Scaldaferri
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniele Napolitano
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessia Todeschini
- IBD Unit - IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Andrea Geccherle
- IBD Unit - IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Nicoletta Colaci
- Unità per la Ricerca Clinica, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Maria Guerra
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Monica Annese
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - Anna Caiazzo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - Francesco Simone Conforti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Greta Lorenzon
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Ambra Magiotta
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Flavia Baccini
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department - ASST Lecco, Italy
| | | | - Marta Vernero
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, And Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
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8
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Kubesch A, Kruse N, Jungheim F, Balaban Ü, Stratmann K, Sprinzl K, Dienethal A, Krause T, Zeuzem S, Blumenstein I. Switching Vedolizumab from IV to SC Injection in Inflammatory Bowel Disease Patients with Active Disease: Real-World Experience from a German IBD Cohort. J Clin Med 2023; 12:7657. [PMID: 38137726 PMCID: PMC10743496 DOI: 10.3390/jcm12247657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Vedolizumab (VDZ) for subcutaneous (SC) injection was approved for use in Europe in 2020 and the US in 2023. Promising efficacy and tolerability have been proven in pivotal trials. However, real-world data on the SC use of VDZ, especially in patients with active disease, are still lacking. We aimed to determine treatment persistence and the drug's efficacy in inflammatory bowel disease (IBD) patients with active disease in comparison to patients in clinical remission. METHODS Patients treated for IBD in a tertiary care center from July 2020 to December 2021 were included in this study. Clinical and biochemical parameters and data on treatment adherence were collected. VDZ trough levels and disease activity before and after the switch from intravenous (IV) to SC injections were monitored during routine checkups and were retrospectively analyzed. The patients were followed up until week 20. RESULTS Eighty-two patients were included in the study. Of them, 35 patients had active disease (35/82 = 43%) at the time of the switch and 47 patients (47/82 = 57%) were in remission. In total, 10 patients experienced switch failure, 5 were switched back to IV VDZ, and 5 were swapped to a different biologic agent. We observed an increase in VDZ trough levels from the switch to week 8 and from the switch to week 20 in the remission group. Vedolizumab trough levels of 7.4, 51.4, and 33.45 ug/mL at the switch, week 8, and week 20 were identified to discriminate between remission and disease activity in our cohort. There was no new safety signal detected during the study period. CONCLUSIONS The switch from IV to SC VDZ proved to be efficient, safe, and even capable of reducing residual disease activity.
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Affiliation(s)
- Alica Kubesch
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Nina Kruse
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Florian Jungheim
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Ümniye Balaban
- Institute of Biostatistics and Mathematical Modeling, University Hospital, Goethe University, 60596 Frankfurt a.M., Germany;
| | - Katharina Stratmann
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Kathrin Sprinzl
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Antje Dienethal
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Thomas Krause
- Gastroenterologie Opernstrasse, 34117 Kassel, Germany;
| | - Stefan Zeuzem
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
| | - Irina Blumenstein
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, 60596 Frankfurt a.M., Germany; (A.K.); (N.K.); (F.J.); (K.S.); (A.D.); (S.Z.)
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Sandborn WJ, Chen J, Kisfalvi K, Loftus EV, D’Haens G, Candela N, Lasch K, Wolf DC, Uddin SM, Danese S. Practical Primer Addressing Real-World Use Scenarios of Subcutaneous Vedolizumab in Ulcerative Colitis and Crohn's Disease: Post Hoc Analyses of VISIBLE Studies. CROHN'S & COLITIS 360 2023; 5:otad034. [PMID: 37636008 PMCID: PMC10449415 DOI: 10.1093/crocol/otad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Indexed: 08/29/2023] Open
Abstract
Background Vedolizumab, an anti-α4β7 integrin approved for intravenous (IV) treatment of moderately to severely active ulcerative colitis (UC) and Crohn's disease (CD), was evaluated as a subcutaneous (SC) formulation in maintenance therapy for UC and CD in phase 3 VISIBLE 1, 2, and open-label extension studies, and recently approved in Europe, Australia, and Canada. Our aim was to evaluate efficacy and safety of IV and SC vedolizumab in clinically relevant UC and CD scenarios. Methods Post hoc data analyses from VISIBLE trials examined: (1) whether baseline characteristics predict clinical response to 2 vs 3 IV vedolizumab induction doses; (2) efficacy and safety of switching during maintenance vedolizumab IV to SC in patients with UC; (3) vedolizumab SC after treatment interruption of 1-46 weeks; (4) increasing dose frequency of vedolizumab SC from every 2 weeks (Q2W) to every week (QW) after disease worsening. Results No baseline characteristics were identified as strong predictors of response to 2 vs 3 vedolizumab infusions. Most patients achieved clinical response after 2 or 3 doses of IV vedolizumab maintained with SC treatment. Clinical remission and response rates were maintained in patients transitioned from maintenance vedolizumab IV to SC treatment. Of patients with UC, ≥75% achieved response following resumption after dose interruption. Escalation to QW dosing resulted in ≥45% of patients regaining response after loss while receiving vedolizumab Q2W. Conclusions Clinical real-world scenarios with vedolizumab SC were reviewed using VISIBLE studies data. Vedolizumab SC provides an additional dosing option for patients with UC and CD.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Jingjing Chen
- Department of Statistics and Quantitative Sciences, Takeda Development Center Americas Inc., Cambridge, MA, USA
| | - Krisztina Kisfalvi
- Department of Statistics and Quantitative Sciences, Takeda Development Center Americas Inc., Cambridge, MA, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Geert D’Haens
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ninfa Candela
- Department of Gastroenterology, Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
| | - Karen Lasch
- Department of Gastroenterology, Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
| | - Douglas C Wolf
- Department of US Medical, Atlanta Gastroenterology Associates, Atlanta, GA, USA
| | - Sharif M Uddin
- Department of Gastroenterology, Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
| | - Silvio Danese
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
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