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Bamias G, Kokkotis G, Gizis M, Kapizioni C, Karmiris K, Koureta E, Kyriakos N, Leonidakis G, Makris K, Markopoulos P, Michalopoulos G, Michopoulos S, Papaconstantinou I, Polymeros D, Siakavellas SI, Triantafyllou K, Tsironi E, Tsoukali E, Tzouvala M, Viazis N, Xourafas V, Zacharopoulou E, Zampeli E, Zografos K, Papatheodoridis G, Mantzaris G. Predictors of Response to Vedolizumab in Patients with Ulcerative Colitis: Results from the Greek VEDO-IBD Cohort. Dig Dis Sci 2022; 67:1007-1017. [PMID: 33751325 PMCID: PMC7942521 DOI: 10.1007/s10620-021-06907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Optimization of treatment with biologics is currently an unmet need for patients with ulcerative colitis (UC). Real-world studies provide neutral estimates of drug efficacy and safety within unselected patient populations and allow for the recognition of specific characteristics that affect response to therapy. AIMS We aimed to depict the efficacy of vedolizumab in patients with UC in a real-world setting and identify prognosticators of improved outcomes. METHODS Patients with active UC who commenced treatment with vedolizumab were prospectively followed up. Patient-reported outcomes (PROs) and clinical/endoscopic-reported outcomes were recorded at baseline and at weeks 14 and 54. Predefined endpoints of early and persistent efficacy were analyzed against clinical characteristics to identify prognostic factors for response. RESULTS We included 96 patients (anti-TNF-exposed = 38.5%). At week 14, 73 patients (76%) had clinical response and 54 (56.3%) clinical remission. At week 54, the primary endpoint of vedolizumab persistence was met by 72 patients (75%), whereas steroid-free clinical remission by 59.4%. Among patients who had endoscopy, rates for mucosal healing (Mayo endoscopic score of 0) were 29.8% at week 14 and 44.6% at week 54, respectively. Vedolizumab treatment led to significant improvements in quality of life. Corticosteroid-refractory or anti-TNF-refractory disease, articular manifestations, and high baseline UC-PRO2 were associated with decreased efficacy of vedolizumab in the primary and secondary outcomes. CONCLUSIONS Vedolizumab is characterized by high efficacy and long-term treatment persistence in UC. More aggressive disease, as indicated by refractoriness to steroids or anti-TNFs and elevated baseline PROs, may predict suboptimal response and help pre-treatment prognostic stratification of patients.
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Affiliation(s)
- Giorgos Bamias
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Georgios Kokkotis
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Michalis Gizis
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Christina Kapizioni
- Department of Gastroenterology, Tzaneion General Hospital, Leoforos Afentouli, 18536 Piraeus, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Leoforos Knosou 44, 71409 Heraklion, Greece
| | - Evgenia Koureta
- Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Nikolaos Kyriakos
- Department of Gastroenterology, 401 General Military Hospital of Athens, Leoforos Panagioti Kanellopoulou, 11525 Athens, Greece
| | - Georgios Leonidakis
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Konstantinos Makris
- Department of Gastroenterology, Tzaneion General Hospital, Leoforos Afentouli, 18536 Piraeus, Greece
| | - Panagiotis Markopoulos
- Department of Gastroenterology, Metaxa Memorial General Hospital, Mpotasi 51, 18537 Piraeus, Greece
| | - Georgios Michalopoulos
- Department of Gastroenterology, Tzaneion General Hospital, Leoforos Afentouli, 18536 Piraeus, Greece
| | - Spyridon Michopoulos
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, Leoforos Vasilissis Sofias 76, 11528 Athens, Greece
| | - Dimitrios Polymeros
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Spyros I. Siakavellas
- Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Eftychia Tsironi
- Department of Gastroenterology, Metaxa Memorial General Hospital, Mpotasi 51, 18537 Piraeus, Greece
| | - Emmanouela Tsoukali
- Department of Gastroenterology, GHA Evaggelismos- Opthalmiatreion Athinon-Polykliniki, Ipsilantou 45-47, 10676 Athens, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital Nikaias-Piraeus “Agios Panteleimon” -General Hospital Dytikis Attikis “Agia Varvara”, Dim. Mantouvalou 3, 18454 Athens, Greece
| | - Nikos Viazis
- Department of Gastroenterology, GHA Evaggelismos- Opthalmiatreion Athinon-Polykliniki, Ipsilantou 45-47, 10676 Athens, Greece
| | - Vassileios Xourafas
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - Eirini Zacharopoulou
- Department of Gastroenterology, General Hospital Nikaias-Piraeus “Agios Panteleimon” -General Hospital Dytikis Attikis “Agia Varvara”, Dim. Mantouvalou 3, 18454 Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Konstantinos Zografos
- GI Unit, 3Rd Department of Internal Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Messogeion 152, 11527 Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Gerasimos Mantzaris
- Department of Gastroenterology, GHA Evaggelismos- Opthalmiatreion Athinon-Polykliniki, Ipsilantou 45-47, 10676 Athens, Greece
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D'Amico F, Peyrin-Biroulet L, Danese S, Fiorino G. New drugs in the pipeline for the treatment of inflammatory bowel diseases: what is coming? Curr Opin Pharmacol 2020; 55:141-150. [PMID: 33254032 DOI: 10.1016/j.coph.2020.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022]
Abstract
Over the past twenty years several biological drugs and the first small molecule have been approved for the treatment of patients with inflammatory bowel diseases (IBD). However, a large percentage of patients do not respond to therapies and the demand for new effective drugs is still an unmet need. The better understanding of the pathophysiological mechanisms of disease has allowed to identify new therapeutic targets to block inflammatory pathways. To date, many emerging drugs have been developed and are being tested for both ulcerative colitis and Crohn's disease patients. Here, we summarize the efficacy and safety data of the most promising drugs that could soon enrich the therapeutic armamentarium of IBD patients.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
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