Vedolizumab’s Impact on Postoperative Crohn’s Disease Recurrence

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G D’Haens et al. Lancet Gastroenterol Hepatol 2025; 10: 26-33. Vedolizumab to prevent postoperative recurrence of Crohn’s disease (REPREVIO): a multicentre, double-blind, randomised, placebo-controlled trial

In the REPREVIO study,  a double-blind, randomized, placebo-controlled trial, 80 adults received either vedolizumab (300 mg IV) (n=43) or placebo (n=37) at weeks 0, 8, 16 and 24 following ileocolonic resection and had one or more risk factors for recurrence.

Key findings:

  • At week 26, the probability of a lower modified Rutgeerts score with vedolizumab versus placebo was 77·8% (95% CI 66·4 to 86·3; p<0·0001).
  • Severe endoscopic recurrence was observed in ten (23·3%) of 43 patients in the vedolizumab group versus 23 (62·2%) of 37 patients in the placebo group (difference –38·9% [95% CI –56·0 to –17·3]; p=0·0004). 
  • Adverse effects were noted in three patients who received vedolizumab (bilateral tubo-ovarian abscesses, thrombosed hemorrhoids, and pancreatic adenocarcinoma) and two patients who received placebo (intestinal perforation related to Crohn’s disease and severe abdominal pain)

My take: This study shows that vedolizumab is another biologic capable of reducing postoperative recurrence following ileocolonic resection in Crohn’s disease. Infliximab has been shown to reduce recurrence as well (shown in the PREVENT study).

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