Vedolizumab Success Rate Appears Low in Active Perianal Crohn Disease

It is unlikely for patients with active perianal Crohn disease (CD) who receive treatment with vedolizumab and no other medical or surgical treatment to reach clinical success at 6 months, according to results of a new study.

To examine the effectiveness of vedolizumab in perianal CD, the researchers conducted a study in 17 centers throughout France. From October 2017 to June 2018, 151 patients who had had perianal CD for at least 3 months and who had received vedolizumab were included. Data on the 102 patients with active perianal CD at vedolizumab initiation were analyzed. 

Among these patients with active perianal CD, the mean age was 39.8 years, and the mean CD duration was 14.6 years. Furthermore, 32.4% of the patients were men, and 99% had received treatment with at least 1 anti‐tumor necrosis factor medication. The median follow‐up time was 52 weeks, with 68% of patients discontinuing therapy after a median time of 33 weeks.

Of the 102 patients, 23 (22.5%) reached clinical success with vedolizumab, which was defined as no draining fistula at clinical examination and no anal ulcers for primary lesions at 6 months without medical or surgical treatment for perianal CD.

Among the 61 patients with setons at initiation, 9 (15%) had a successful removal during follow-up.

In the multivariable analysis, the researchers identified predictors of success and determined that the number of prior biologic agents (≥3, odds ratio [OR], 0.13; 95% CI, 0.02-1.09) and no antibiotics at initiation (OR, 4.12; 95% CI, 1.06-15.98) were factors that were associated with success.

The researchers also assessed perianal recurrence—which was defined by the occurrence of lesions and/or the need for medical or surgical treatments—among the 49 patients who had inactive perianal CD; they found that perianal disease recurred in 30.6% of the patients. Dedicated treatments were needed by 22.4% of those with inactive perianal CD. The median time to recurrence was 22 weeks.

“We identified a low rate of success of vedolizumab in patients with active perianal [CD], and nearly one-third of patients with inactive perianal [CD] had perianal recurrence,” the researchers concluded. “Further evaluation is warranted in prospective studies.”

—Colleen Murphy

Reference:

Chapuis‐Biron C, Bourrier A, Nachury M, et al; GETAID BioLAP Study Group. Vedolizumab for perianal Crohn’s disease: a multicentre cohort study in 151 patients [published online February 20, 2020]. Aliment Pharmacol Ther. doi:10.1111/apt.15665