A recent cross-sectional study (B Al-Bawardy et al. Inflamm Bowel Dis 2019; 25: 580-6) correlated vedolizumab (VDZ) trough drug levels (VDT) and clinical outcomes in 171 patients (62% Crohn’s disease (CD), 31% ulcerative colitis (UC), and 7% indeterminate colitis (IC)).
- Median VDT was 15.3 microgr/mL.
- Median VDT was 17.3 microgr/mL for patients with normal CRP compared with 10.7 for patients with high CRP. This differnece was noted significantly for CD (20.3 vs 10.4) but not for UC.
- No relationship between VDT and mucosal healing was noted.
- Shorter dose intervals and lower BMO resulted in higher VTLs
- Only 1 patient had detectable antibodies to VDZ
A second systematic review (L Peyrin-Biroulet et al. Clin Gastroenterol Hepatol 2019; 17: 838-46) analyzed data from 10 cohorts who had received vedolizumab. Most had prior anti-TNF exposure. Key finding: the pooled incidence rates of loss of response were 47.9 per 100 person-years of follow up among patients with CD and 39.8 per 100 person-years of follow up among patinets with UC. Dose intensification restored response to the drug in 53.8% of secondary non-responders.
My take: While VDZ dose intensification can restore response, the utility of therapeutic drug monitoring is unclear with VDZ therapy.
Related blog posts:
- Vedolizumab Drug Levels –Are They Helpful?
- Therapeutic drug monitoring for vedolizumab
- A Bunch of Data on Vedolizumab