Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis

David M. Faleck, Adam Winters, Shreya Chablaney, Preeti Shashi, Joseph Meserve, Aaron Weiss, Satimai Aniwan, Jenna L. Koliani-Pace, Gursimran Kochhar, Brigid S. Boland, Siddharth Singh, Robert Hirten, Eugenia Shmidt, Varun Kesar, Karen Lasch, Michelle Luo, Matthew Bohm, Sashidhar Varma, Monika Fischer, David HudesmanShannon Chang, Dana J. Lukin, Keith Sultan, Arun Swaminath, Nitin Gupta, Corey A. Siegel, Bo Shen, William J. Sandborn, Sunanda Kane, Edward V. Loftus, Bruce E. Sands, Jean Frederic Colombel, Parambir S. Dulai, Ryan Ungaro

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background & Aims: Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration. Methods: We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. Results: Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38% vs 23%), CSFR (43% vs 14%), and endoscopic remission (29% vs 13%) (P <.05 for all comparisons). After adjusting for disease-related factors including previous exposure to TNF antagonists, patients with early-stage CD were significantly more likely than patients with later-stage CD to achieve clinical remission (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.02–2.49), CSFR (aHR, 3.39; 95% CI, 1.66–6.92), and endoscopic remission (aHR, 1.90; 95% CI, 1.06–3.39). In contrast, disease duration was not a significant predictor of response among patients with UC. Conclusions: Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer disease duration. Disease duration does not associate with response vedolizumab in patients with UC.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StatePublished - Jan 1 2019

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Ulcerative Colitis
Crohn Disease
Adrenal Cortex Hormones
vedolizumab
Tumor Necrosis Factor-alpha
Biological Factors
Proportional Hazards Models

Keywords

  • Inflammatory Bowel Disease
  • Integrin
  • Monoclonal Antibody Therapy
  • Time

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis. / Faleck, David M.; Winters, Adam; Chablaney, Shreya; Shashi, Preeti; Meserve, Joseph; Weiss, Aaron; Aniwan, Satimai; Koliani-Pace, Jenna L.; Kochhar, Gursimran; Boland, Brigid S.; Singh, Siddharth; Hirten, Robert; Shmidt, Eugenia; Kesar, Varun; Lasch, Karen; Luo, Michelle; Bohm, Matthew; Varma, Sashidhar; Fischer, Monika; Hudesman, David; Chang, Shannon; Lukin, Dana J.; Sultan, Keith; Swaminath, Arun; Gupta, Nitin; Siegel, Corey A.; Shen, Bo; Sandborn, William J.; Kane, Sunanda; Loftus, Edward V.; Sands, Bruce E.; Colombel, Jean Frederic; Dulai, Parambir S.; Ungaro, Ryan.

In: Clinical Gastroenterology and Hepatology, 01.01.2019.

Research output: Contribution to journalArticle

Faleck, DM, Winters, A, Chablaney, S, Shashi, P, Meserve, J, Weiss, A, Aniwan, S, Koliani-Pace, JL, Kochhar, G, Boland, BS, Singh, S, Hirten, R, Shmidt, E, Kesar, V, Lasch, K, Luo, M, Bohm, M, Varma, S, Fischer, M, Hudesman, D, Chang, S, Lukin, DJ, Sultan, K, Swaminath, A, Gupta, N, Siegel, CA, Shen, B, Sandborn, WJ, Kane, S, Loftus, EV, Sands, BE, Colombel, JF, Dulai, PS & Ungaro, R 2019, 'Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2018.12.040
Faleck, David M. ; Winters, Adam ; Chablaney, Shreya ; Shashi, Preeti ; Meserve, Joseph ; Weiss, Aaron ; Aniwan, Satimai ; Koliani-Pace, Jenna L. ; Kochhar, Gursimran ; Boland, Brigid S. ; Singh, Siddharth ; Hirten, Robert ; Shmidt, Eugenia ; Kesar, Varun ; Lasch, Karen ; Luo, Michelle ; Bohm, Matthew ; Varma, Sashidhar ; Fischer, Monika ; Hudesman, David ; Chang, Shannon ; Lukin, Dana J. ; Sultan, Keith ; Swaminath, Arun ; Gupta, Nitin ; Siegel, Corey A. ; Shen, Bo ; Sandborn, William J. ; Kane, Sunanda ; Loftus, Edward V. ; Sands, Bruce E. ; Colombel, Jean Frederic ; Dulai, Parambir S. ; Ungaro, Ryan. / Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis. In: Clinical Gastroenterology and Hepatology. 2019.
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abstract = "Background & Aims: Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration. Methods: We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. Results: Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38{\%} vs 23{\%}), CSFR (43{\%} vs 14{\%}), and endoscopic remission (29{\%} vs 13{\%}) (P <.05 for all comparisons). After adjusting for disease-related factors including previous exposure to TNF antagonists, patients with early-stage CD were significantly more likely than patients with later-stage CD to achieve clinical remission (adjusted hazard ratio [aHR], 1.59; 95{\%} CI, 1.02–2.49), CSFR (aHR, 3.39; 95{\%} CI, 1.66–6.92), and endoscopic remission (aHR, 1.90; 95{\%} CI, 1.06–3.39). In contrast, disease duration was not a significant predictor of response among patients with UC. Conclusions: Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer disease duration. Disease duration does not associate with response vedolizumab in patients with UC.",
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TY - JOUR

T1 - Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis

AU - Faleck, David M.

AU - Winters, Adam

AU - Chablaney, Shreya

AU - Shashi, Preeti

AU - Meserve, Joseph

AU - Weiss, Aaron

AU - Aniwan, Satimai

AU - Koliani-Pace, Jenna L.

AU - Kochhar, Gursimran

AU - Boland, Brigid S.

AU - Singh, Siddharth

AU - Hirten, Robert

AU - Shmidt, Eugenia

AU - Kesar, Varun

AU - Lasch, Karen

AU - Luo, Michelle

AU - Bohm, Matthew

AU - Varma, Sashidhar

AU - Fischer, Monika

AU - Hudesman, David

AU - Chang, Shannon

AU - Lukin, Dana J.

AU - Sultan, Keith

AU - Swaminath, Arun

AU - Gupta, Nitin

AU - Siegel, Corey A.

AU - Shen, Bo

AU - Sandborn, William J.

AU - Kane, Sunanda

AU - Loftus, Edward V.

AU - Sands, Bruce E.

AU - Colombel, Jean Frederic

AU - Dulai, Parambir S.

AU - Ungaro, Ryan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background & Aims: Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration. Methods: We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. Results: Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38% vs 23%), CSFR (43% vs 14%), and endoscopic remission (29% vs 13%) (P <.05 for all comparisons). After adjusting for disease-related factors including previous exposure to TNF antagonists, patients with early-stage CD were significantly more likely than patients with later-stage CD to achieve clinical remission (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.02–2.49), CSFR (aHR, 3.39; 95% CI, 1.66–6.92), and endoscopic remission (aHR, 1.90; 95% CI, 1.06–3.39). In contrast, disease duration was not a significant predictor of response among patients with UC. Conclusions: Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer disease duration. Disease duration does not associate with response vedolizumab in patients with UC.

AB - Background & Aims: Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration. Methods: We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. Results: Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38% vs 23%), CSFR (43% vs 14%), and endoscopic remission (29% vs 13%) (P <.05 for all comparisons). After adjusting for disease-related factors including previous exposure to TNF antagonists, patients with early-stage CD were significantly more likely than patients with later-stage CD to achieve clinical remission (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.02–2.49), CSFR (aHR, 3.39; 95% CI, 1.66–6.92), and endoscopic remission (aHR, 1.90; 95% CI, 1.06–3.39). In contrast, disease duration was not a significant predictor of response among patients with UC. Conclusions: Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer disease duration. Disease duration does not associate with response vedolizumab in patients with UC.

KW - Inflammatory Bowel Disease

KW - Integrin

KW - Monoclonal Antibody Therapy

KW - Time

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U2 - 10.1016/j.cgh.2018.12.040

DO - 10.1016/j.cgh.2018.12.040

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JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

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