Maintenance of remission among patients with inflammatory bowel disease after vedolizumab discontinuation: a multicentre cohort study

Antoine Martin (1) , Maria Nachury (2) , Laurent Peyrin-Biroulet (3, 4) , Yoram Bouhnik (5) , Stephane Nancey (6) , Anne Bourrier (7) , Mélanie Serrero (8) , Mathurin Fumery (9) , Anthony Buisson (10) , David Laharie (11) , Cyrielle Gilletta (12) , Jérome Filippi (13) , Matthieu Allez (14) , Guillaume Bouguen (15, 16) , Xavier Roblin (17) , Romain Altwegg (18) , Nina Dib (19) , Guillaume Pineton de Chambrun (18) , Guillaume Savoye (20, 21, 22, 23) , Franck Carbonnel (24) , Stephanie Viennot (25) , Aurélien Amiot (26)

1 CHU Henri Mondor [Créteil]
2 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
3 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
4 Service d'Hépato-gastro-entérologie [CHRU Nancy]
5 Hôpital Beaujon [AP-HP]
6 HCL - Hospices Civils de Lyon
7 CRSA - Centre de Recherche Saint-Antoine
8 CIC - Biotherapie - Marseille
9 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
10 CHU Estaing [Clermont-Ferrand]
11 Hôpital Haut-Lévêque [CHU Bordeaux]
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 CHU Nice - Centre Hospitalier Universitaire de Nice
14 AP-HP - Hopital Saint-Louis [AP-HP]
15 CIC - Centre d'Investigation Clinique [Rennes]
16 NuMeCan - Nutrition, Métabolismes et Cancer
17 Service de Gastro-entérologie et Hépatologie [CHU Saint-Etienne]
18 CHU Montpellier
19 CHU Angers - Centre Hospitalier Universitaire d'Angers
20 Service d'Hépato-Gastroentérologie [CHU Rouen]
21 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
22 IRIB - Institute for Research and Innovation in Biomedicine
23 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
24 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
25 Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]
26 Service d'hépato-gastro-entérologie [APHP Henri Mondor]

Background and aim - It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. Methods - This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. Results - A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 [5.8-17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33-0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21-0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. Conclusions - In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.

Mots clés: Crohn’s disease; ulcerative colitis; inflammatory bowel disease; vedolizumab

Domaines: Sciences du Vivant [q-bio]

Antoine Martin, Maria Nachury, Laurent Peyrin-Biroulet, Yoram Bouhnik, Stephane Nancey, et al.. Maintenance of remission among patients with inflammatory bowel disease after vedolizumab discontinuation: a multicentre cohort study. Journal of Crohn's and Colitis, 2020, 14 (7), pp.896-903. ⟨10.1093/ecco-jcc/jjaa005⟩. ⟨hal-02442530⟩