Potential benefits of immunomodulator use with vedolizumab for maintenance of remission in ulcerative colitis

Makoto Naganuma, Kenji Watanabe, Satoshi Motoya, Haruhiko Ogata, Toshiyuki Matsui, Yasuo Suzuki, Lyann Ursos, Shigeru Sakamoto, Mitsuhiro Shikamura, Tetsuharu Hori, Jovelle Fernandez, Mamoru Watanabe, Toshifumi Hibi, Takanori Kanai, Makoto Naganuma, Kenji Watanabe, Satoshi Motoya, Haruhiko Ogata, Toshiyuki Matsui, Yasuo Suzuki, Lyann Ursos, Shigeru Sakamoto, Mitsuhiro Shikamura, Tetsuharu Hori, Jovelle Fernandez, Mamoru Watanabe, Toshifumi Hibi, Takanori Kanai

Abstract

Background and aim: This study aimed to determine the efficacy and safety of vedolizumab treatment with or without concomitant immunomodulator use in Japanese patients with moderate-to-severe ulcerative colitis.

Methods: Among enrolled patients in a phase 3 study conducted in Japan (clinicaltrials.gov, NCT02039505), data from patients allocated to 300-mg intravenous vedolizumab for induction and maintenance phases were used for this exploratory analysis. Efficacy endpoints were clinical response, clinical remission, and mucosal healing at week 10 and clinical remission and mucosal healing at week 60, and disease worsening and treatment failure during the maintenance phase.

Results: At week 10, the differences in clinical response, clinical remission, and mucosal healing rates between the subgroups (those with concomitant immunomodulator use minus those without) were 0.7 (95% confidence interval: -14.3, 15.7), 3.3 (95% confidence interval: -8.5, 15.2), and 1.8 (95% confidence interval: -13.0, 16.5), respectively. At week 60, the differences in clinical remission and mucosal healing between the subgroups with and without concomitant immunomodulator use were 26.1 (95% confidence interval: -3.5, 55.6) and 29.9 (95% confidence interval: 1.4, 58.4), respectively. The proportions of patients without treatment failure at day 330 of the maintenance phase were 90.7% with concomitant immunomodulator use and 73.7% without. No marked differences in incidence of infections were observed between subgroups.

Conclusions: This study suggested the possibility that concomitant immunomodulator use may be beneficial to maintain the clinical efficacy of vedolizumab.

Keywords: Immunomodulation; Ulcerative colitis; Vedolizumab.

© 2021 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Figures

Figure 1
Figure 1
Efficacy endpoints at week 10. CI, confidence interval; IM, immunomodulator. ▪▪▪, with IM (n = 80); ▪▪▪, without IM (n = 84).
Figure 2
Figure 2
Efficacy endpoints at week 60. CI, confidence interval; IM, immunomodulator. ▪▪▪, with IM (n = 22); ▪▪▪, without IM (n = 19).
Figure 3
Figure 3
(a) Time to disease worsening and (b) time to treatment failure during maintenance phase by concomitant immunomodulator (IM) at week 0. ▪▪▪, with IM (n = 22 at day 0); ▪▪▪, without IM (n = 19 at day 0).

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