A recent review (A Barre, JF Colmbrel, R Ungaro. Alim Pharm Ther 2018
- “Vedolizumab is a humanised monoclonal gut-selective antibody against α4β7 integrin and inhibits the trafficking of inflammatory cells to the intestine.”
- From Vedolizumab GEMINI trials, , “primary response to vedolizumab was typically evaluated at week 14 after induction with rates of clinical remission and clinical response ranging between 24%-36% and 49%-64% in CD, and 23%-39% and 43%-57% in UC, respectively”
- “Ustekinumab is a monoclonal IgG1 antibody against the p40 subunit of interleukin-12 (IL-12) and interleukin-23 (IL-23) that targets both the T-helper 1 and T-helper 17 pathways involved in the pathogenesis of CD.”
- With Ustekinumab, “in real-world observational studies, patients were treated off-label and received highly variable induction and maintenance dosing, thus limiting the generalizability of results. The rates of response were reported to be as high as 84% and remission rates as high as 35% at end of induction, with loss of response in around one-third of patients during maintenance”
- Patients with severe disease (by clinical activity and inflammatory biomarkers), and prior anti-TNF exposure are less likely to respond to vedolizumab.
- Ileocolonic disease, no prior surgery and uncomplicated phenotype were associated with better responses to ustekinumab in CD
With ustekinumab, in particular, there is still very limited data on its effectiveness and long-term outcomes and this is even more the case in pediatrics. This review does a good job in compiling the current available data.
My take: While this is a nice review, it does not help me much with developing an algorithm for how I will use these relatively new medications for IBD.
Related blog posts:
- Therapeutic drug monitoring for ustekinumab (Stelara)
- Ustekinumab for Crohn’s Disease
- Ustekinumab: NASPGHAN17 Poster from CHOP This link has a poster (at the bottom of this post) explaining CHOP’s pediatric experience with ustekinumab (which showed a pretty limited response)
- Summary of latest information on Vedolizumab
- GI Care for Kids Data on Vedolizumab 2017
- Latest on Vedolizumab
- Pediatric Experience with Vedolizumab | gutsandgrowth
- Vedolizumab -another new IBD treatment | gutsandgrowth
- Early Look At Entyvio (Vedolizumab) in Pediatrics | gutsandgrowth
- Enthusiasm for Vedolizumab | gutsandgrowth