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Plevris N, Chuah CS, Allen RM, Arnott ID, Brennan PN, Chaudhary S, Churchhouse AMD, Din S, Donoghue E, Gaya DR, Groome M, Jafferbhoy HM, Jenkinson PW, Lam WL, Lyons M, Macdonald JC, MacMaster M, Mowat C, Naismith GD, Potts LF, Saffouri E, Seenan JP, Sengupta A, Shasi P, Sutherland DI, Todd JA, Veryan J, Watson AJM, Watts DA, Jones GR, Lees CW. Real-world Effectiveness and Safety of Vedolizumab for the Treatment of Inflammatory Bowel Disease: The Scottish Vedolizumab Cohort. J Crohns Colitis 2019; 13:1111-1120. [PMID: 30768123 DOI: 10.1093/ecco-jcc/jjz042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Vedolizumab is an anti-a4b7 monoclonal antibody that is licensed for the treatment of moderate to severe Crohn's disease and ulcerative colitis. The aims of this study were to establish the real-world effectiveness and safety of vedolizumab for the treatment of inflammatory bowel disease. METHODS This was a retrospective study involving seven NHS health boards in Scotland between June 2015 and November 2017. Inclusion criteria included: a diagnosis of ulcerative colitis or Crohn's disease with objective evidence of active inflammation at baseline (Harvey-Bradshaw Index[HBI] ≥5/Partial Mayo ≥2 plus C-reactive protein [CRP] >5 mg/L or faecal calprotectin ≥250 µg/g or inflammation on endoscopy/magnetic resonance imaging [MRI]); completion of induction; and at least one clinical follow-up by 12 months. Kaplan-Meier survival analysis was used to establish 12-month cumulative rates of clinical remission, mucosal healing, and deep remission [clinical remission plus mucosal healing]. Rates of serious adverse events were described quantitatively. RESULTS Our cohort consisted of 180 patients with ulcerative colitis and 260 with Crohn's disease. Combined median follow-up was 52 weeks (interquartile range [IQR] 26-52 weeks). In ulcerative colitis, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 57.4%, 47.3%, and 38.5%, respectively. In Crohn's disease, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 58.4%, 38.9%, and 28.3% respectively. The serious adverse event rate was 15.6 per 100 patient-years of follow-up. CONCLUSIONS Vedolizumab is a safe and effective treatment for achieving both clinical remission and mucosal healing in ulcerative colitis and Crohn's disease.
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Affiliation(s)
- N Plevris
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - C S Chuah
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - R M Allen
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - I D Arnott
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - P N Brennan
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - S Chaudhary
- Department of Gastroenterology, University Hospital Hairmyres, East Kilbride, UK
| | | | - S Din
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - E Donoghue
- Department of Gastroenterology, Forth Valley Royal Hospital, Larbert, UK
| | - D R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - M Groome
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - H M Jafferbhoy
- Department of Gastroenterology, Victoria Hospital, Kirkcaldy, UK
| | - P W Jenkinson
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.,Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - W L Lam
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - M Lyons
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - J C Macdonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M MacMaster
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - C Mowat
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - G D Naismith
- Department of Gastroenterology, Royal Alexandra Hospital, Paisley, UK
| | - L F Potts
- Department of Gastroenterology, Raigmore Hospital, Inverness, UK
| | - E Saffouri
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - J P Seenan
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - A Sengupta
- Department of Gastroenterology, Victoria Hospital, Kirkcaldy, UK
| | - P Shasi
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - D I Sutherland
- Department of Gastroenterology, University Hospital Hairmyres, East Kilbride, UK
| | - J A Todd
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - J Veryan
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - A J M Watson
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - D A Watts
- Department of Gastroenterology, Forth Valley Royal Hospital, Larbert, UK
| | - G R Jones
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - C W Lees
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
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Lynch RW, Churchhouse AMD, Protheroe A, Arnott IDR. Predicting outcome in acute severe ulcerative colitis: comparison of the Travis and Ho scores using UK IBD audit data. Aliment Pharmacol Ther 2016; 43:1132-41. [PMID: 27060985 DOI: 10.1111/apt.13614] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/13/2015] [Accepted: 03/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute severe ulcerative colitis is categorised using the Truelove & Witts criteria. The Travis and the Ho scores are calculated following 72 h of steroid treatment to identify patients at risk of failing steroid therapy who require colectomy or second-line medical therapy. AIM To compare the Travis and the Ho scores in a large unselected cohort to determine which might be more clinically relevant. METHODS We analysed 3049 patients with ulcerative colitis from the 2010 round of the UK IBD audit of which 984 had acute severe ulcerative colitis. 420 patients had sufficient data for analysis. Patients were allocated into either a Travis high- or low-risk group and either a Ho high-, intermediate- or low-risk group. We assessed whether further medical or surgical intervention and outcomes varied between groups. RESULTS High-risk patients in Travis and the Ho groups, when compared to lower risk groups, were more likely to fail steroid therapy: 64.5% (131/203) vs. 38.7% (84/217) (P < 0.0001) for Travis and 66.2% (96/145) vs. 46.7% (85/182) vs. 36.6% (34/93) (P < 0.0001) for Ho. They were also more likely to undergo surgery 34.0% (69/203) vs. 9.7% (21/217) for Travis and 33.1% (48/145) vs. 17.0% (31/182) vs. 11.8% (11/93) (P < 0.0001) for Ho. Travis high patients were more likely to be refractory to second-line medical therapy: 44.6% (37/83) vs. 20.0% (9/45) (P = 0.01). CONCLUSIONS Patients identified as high risk using the Travis or the Ho scoring systems are more likely to be resistant to IV steroids and require surgery. Risk of surgery in both high-risk populations is lower than previously reported.
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Affiliation(s)
- R W Lynch
- GI Unit, Western General Hospital, Edinburgh, UK
| | | | - A Protheroe
- UK IBD Audit, Clinical Effectiveness and Evaluation unit, Royal College of Physicians, London, UK
| | - I D R Arnott
- GI Unit, Western General Hospital, Edinburgh, UK.,UK IBD Audit, Clinical Effectiveness and Evaluation unit, Royal College of Physicians, London, UK
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