🫀 Vedolizumab shows greater efficacy in early Crohn’s disease: Phase 4 results

🧪 What was studied — This open-label cohort study (n=260, 22 hospitals in Belgium, Hungary, Netherlands) compared vedolizumab efficacy and safety between early Crohn’s disease (diagnosis <2 years, biologic-naive, n=86) vs. late Crohn’s disease (>2 years, prior advanced therapy, n=174) over 1 year. Primary endpoint: clinical and endoscopic remission at both week 26 & 52.

📈 Key results — Clinical and endoscopic remission at week 26 & 52 was achieved by 31.4% (early) vs. 8.6% (late), difference of 22.8% (95% CI 12.6–33.7). Serious adverse events: 3.5% (early) vs. 26.4% (late), including infections, surgery, obstruction, and cancer.

📍 What this changes in practice —

• Vedolizumab demonstrates notably higher efficacy and favourable safety in patients with short disease duration and no prior biologics.
• Early biologic-naive patients may benefit most from vedolizumab initiation.
• Supports earlier consideration of vedolizumab for newly diagnosed Crohn’s disease.

🔗 Source — PubMed | DOI 🩸🫀📈✅

🔄 Key takeaways: Biologic withdrawal in IBD—high relapse rates, especially after vedolizumab/ustekinumab

🔥 Main in 3 points

• Relapse after biologic withdrawal is common: 72% overall, 80% for vedolizumab/ustekinumab, 65% for anti-TNFs.
• Shorter time to relapse for non-anti-TNF agents (median 11 vs. 15 months, p=0.002), particularly in Crohn’s.
• Successful reinduction rates are high (83.5% overall).

🧪 Context — Multicentre retrospective study, n=223 IBD patients, withdrawing biologics after remission (n=106 non-anti-TNF; n=117 anti-TNF). Median follow-up: 13 months.

📍 Practical significance

• Discuss relapse risk with IBD patients considering withdrawal, especially after vedolizumab or ustekinumab.
• Prolonged treatment before remission reduces relapse risk (HR 0.93 per month).
• Individualised decision-making and close monitoring essential.

🔗 Source — PubMed | DOI 🧪🩸🔄📌

🧩 Personalized therapy in UC: Histopathology may guide advanced agent selection

✅ Do

• Use Geboes histopathology (neutrophilic infiltration ≥3.2) to identify UC patients likely to respond to IL-23p19 inhibitors (mirikizumab)—all achieved remission in 4 weeks.
• For lower infiltration (<3.2), vedolizumab/upadacitinib led to 100% remission at same interval.

⚠️ With caution

• Further validation is needed for histopathology-driven treatment, but results are promising for targeted therapy.

🚫 Avoid

• A “one size fits all” approach for moderate/severe UC—consider histology to stratify and personalise.

🔗 Source — PubMed | DOI 🧩🧪💍🧑‍⚕️