📈 Vedolizumab Trough Levels: Subcutaneous Route Shows Stronger Predictive Power for Remission in Crohn’s Disease

🔥 Main in 3 points

• Subcutaneous vedolizumab trough concentrations have a stronger ability to predict clinical remission (AUC=0.813, optimal threshold=25.35 µg/mL) than intravenous administration (AUC=0.676, optimal threshold=11.3 µg/mL).
• Remission rates (clinical and biochemical) were numerically higher at higher trough levels, but not statistically significant individually—so context is key.
• Subcutaneous route, higher albumin, and lower FCP are independently linked to increased vedolizumab exposure.

🧪 Context

Retrospective observational study of 69 Crohn's patients on vedolizumab maintenance (IV or SC). Six-month outcomes: clinical (Harvey-Bradshaw Index), biochemical (FCP < 250 µg/g) remission. Troughs measured by ELISA.

📍Practical significance

Subcutaneous dosing may enable better pharmacokinetic monitoring for predicting remission. Use troughs together with albumin and FCP for individualised assessment—not as stand-alone predictors. Consider these variables when strategising on dosing route or escalation.

🔗 Source — PubMed | DOI

🫀 Guideline Update: Advance on Pre-Op Biologic Management in GI Surgery

🔥 Main in 3 points

• New 2025 EU guideline (UEG, ESCP, EAES, SIS-E) for pre-op SSI prevention: recommends alcohol-based chlorhexidine for most GI surgical skin prep.
• Advises discontinuation of anti-TNFs and steroids preoperatively.
• No firm recommendation on stopping vedolizumab or ustekinumab prior to GI surgery due to insufficient evidence.

🧪 Context

Consensus-based European update integrating new evidence since 2018, focusing on digestive surgical infection prevention.

📍 Practical significance

Continue current multidisciplinary pre-op review for vedolizumab/ustekinumab patients—no evidence-backed mandate to stop. Prioritise infection prevention protocols and individual risk assessment.

🔗 Source — PubMed | DOI

🧪 Tuberculosis Risk with Advanced Therapies for IBD Remains Low in the U.S.

🩸 What was studied:

Claims-based cohort (n=20,705) of IBD patients on advanced therapies (TNF antagonists, anti-integrins, anti-ILs) in the U.S. Used weighted Cox models for TB incidence.

📊 Key results:

Incidence of TB was low and similar for TNF antagonists (38/100,000 person-years) and non-TNF biologics (33/100,000). Adjusted HR for TB between biologics: 1.16 (0.41–3.31), indicating no significant difference.

📍What this changes:

Reassures that for IBD patients in low TB incidence settings, advanced therapies—including vedolizumab—carry very low and comparable TB risk. Routine screening and vigilance remain good-practice, but risk is not a differentiator in the U.S.

🔗 Source — PubMed | DOI