Abstract Background Vedolizumab is an established treatment for inflammatory bowel disease (IBD). Loss of response is occasionally encountered. Data regarding dose intensification are limited1. Aim of the study was to evaluate the effectiveness of interval shortening for intravenous vedolizumab (300mg/4 weeks). Methods Data were collected retrospectively from patients’ medical records, in two Greek tertiary centers. All patients received IV vedolizumab every 4 weeks. Response was evaluated at 12 months. The intervention was considered successful if treatment was maintained. Failure was defined as the need for either switching to a different agent or surgery. Results Twenty-one patients 14 (66. 7%) men, median age 53 years (range: 25-85 years) were included. 15 (71. 4%) with ulcerative colitis (UC), 4 (19. 1%) with Crohn’s (CD) and 2 (9. 5%) with pouchitis. Among UC patients, 10 (66. 6%) with left-sided colitis (L2) and 5 (33. 3%) with extensive disease (L3). All CD patients had ileocolitis (L3), whereas two (50%) had stenotic phenotype and two (50%) perianal involvement. Previous treatments: 5-ASA and corticosteroids (95. 2%), immunosuppressants (38. 1%) and biologics (57. 1%). Nine patients were naïve to vedolizumab, whilst 3 patients received the drug as 2nd line and 9 as 3rd therapy. Median duration of vedolizumab treatment, before intensification, was 33 months for UC (IQR: 41) and 19. 5 months for CD (IQR: 35) (p = 0. 41). Median duration of intensified therapy was 9 months for CD (IQR: 24. 5, range 3–48) and 7. 5 months for UC IQR 10, range 3-58, (p = 0. 98). Fourteen (66. 7%) responded to intensification, (11 UC, 2 CD and one with pouchitis). Seven patients failed intensification and switched to another biologic. None underwent surgery. Endoscopy Mayo score decreased from 2. 35 to 0. 88 and the effect was significant (p = 0. 001, r = 0. 79). The mean CRP value decreased significantly from 1. 42 to 0. 44 (p = 0. 007). No treatment-related adverse events were observed. Conclusion Vedolizumab intensification scheme was maintained for more than half of IBD patients beyond six months. The majority were not naïve and required dose escalation no earlier than twelve months after commencement of treatment. Reference: 1. Samaan MA, Birdi S, Morales MS, Honap S, Tamilarasan AG, Cunningham G, Koumoutsos I, Ray S, Mawdsley J, Anderson SHC, Sanderson J, Irving PM. Effectiveness of vedolizumab dose intensification to achieve inflammatory bowel disease control in cases of suboptimal response. Frontline Gastroenterol. 2019 Jul 11;11 (3): 188-193 Conflict of interest: Mr. Pardalis, Pavlos: No conflict of interest Ioannou, Alexandros: No conflict of interest Theocharis, Georgios: No conflict of interest Geramoutsos, Georgios: No conflict of interest Sotiropoulos, Christos: No conflict of interest Delidis, Theodoros: No conflict of interest Dimitriadis, Konstantinos: No conflict of interest Mpakogiannis, Konstantinos: None Leonidakis, George: No conflict of interest Michopoulos, Spyridon: No conflict of interest Zampeli, Evanthia: No conflict of interest
Pardalis et al. (Thu,) studied this question.