Anti-TNF therapy appears effective after first-line Entyvio in IBD
SAN ANTONIO — In patients with inflammatory bowel disease, first-line vedolizumab treatment did not appear to compromise the effectiveness of successive anti-TNF treatment in real-world practice, according to findings presented at the American College of Gastroenterology Annual Meeting.
These results offer a better understanding of the clinical effectiveness of second-line anti-TNF treatment following Entyvio (vedolizumab, Takeda); however, larger studies with longer follow up are needed, according to Andres Yarur, MD, assistant professor of medicine at the Medical College of Wisconsin.
“Vedolizumab is a monoclonal antibody that was approved for [ulcerative colitis] and Crohn's disease several years ago,” he said during a presentation. “Now we have several other new drugs, which is great. We have more opportunities to treat our patients. However, the big question is, how are we going to position these drugs in the therapeutic pyramid of IBD? And specifically, an important question is, if vedolizumab is given as a first-line therapy, what is the efficacy of other drugs, specifically anti-TNF?”
Yarur, along with Brian Bressler, MD, clinical assistant professor of medicine at the University of British Columbia’s department of medicine, and colleagues examined data from the international EVOLVE trial, which is a retrospective study of biologic-naive patients with ulcerative colitis or Crohn’s disease who received first-line anti-TNF or second-line anti-TNF after discontinuation of first-line vedolizumab for any reason. The anti-TNF therapies included Humira (adalimumab, AbbVie), Remicade (infliximab, Janssen), Simponi (golimumab, Janssen) and Cimzia (certolizumab pegol, UCB).
The researchers compared clinical outcomes, including treatment persistence (defined as patients who did not discontinue vedolizumab or anti-TNF treatment), clinical response and remission among patients who received first-line anti-TNF therapy and second-line anti-TNF therapy after first-line treatment with vedolizumab.
Of the 579 patients included in the analysis, 497 patients received first-line anti-TNF treatment (224 with ulcerative colitis, 273 with Crohn’s disease) and 82 patients received second-line anti-TNF treatment after first-line vedolizumab (58 with ulcerative colitis, 24 with Crohn’s disease).
In each cohort, infliximab was administered to 52.7% of patients who received first-line anti-TNF therapy and 79.3% of patients who received second-line anti-TNF therapy after vedolizumab, Bressler and colleagues wrote.
In the first-line anti-TNF group, the mean age at index date was 39.6 years with a median disease duration of 2 years. In the second-line anti-TNF group, the mean age was 49.4 years and median disease duration of 3.7 years, the researchers wrote.
Cumulative rates of treatment persistence (83.9% in the first-line anti-TNF group; 83.6% in the second-line anti-TNF group), clinical response (49.5% in the first-line anti-TNF group; 65.6% in the second-line anti-TNF group), and clinical remission (29.5% in the first-line anti-TNF group; 31.4% in the second-line anti-TNF group) were similar, Bressler and colleagues wrote.
The data further support vedolizumab as a first-line biologic for moderate-to-severe active ulcerative colitis and Crohn’s disease, according to Yarur. However, he warned that the sample size was limited. Therefore, the researchers were unable to account for certain baseline characteristics and reasons for vedolizumab discontinuation.
“These hypothesis-generating data warrant further larger and long-term studies,” Yarur said. - by Earl Holland Jr
Bressler B, et al. Abstract 40. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosure: Yarur reports being a consultant for Takeda Pharmaceuticals. Please see the abstract for all other authors’ relevant financial disclosures.