🫀 Vedolizumab More Effective and Safer in Early Crohn's Disease Compared to Late Disease

🧪 What was studied: The LOVE-CD phase 4 open-label cohort study investigated vedolizumab in adults with moderate-to-severe Crohn's disease across 22 European centres. Patients were stratified as early (diagnosis <2 years, fewer prior advanced therapies) or late (diagnosis >2 years, prior steroids, immunomodulators, anti-TNF). Vedolizumab was given for 52 weeks, with primary outcome being clinical and endoscopic remission (CDAI ≤150; SES-CD <4) at weeks 26 and 52.

📈 Key results: Remission was achieved in 31.4% (27/86) of early CD patients vs 8.6% (15/174) of late CD (difference 22.8%, 95% CI 12.6–33.7). Serious adverse events were lower in early CD (3.5%) than late CD (26.4%), including infections and need for surgery.

📍 What this changes in practice:

• Vedolizumab achieves higher remission and better safety in early, biologic-naive Crohn's disease.
• Early consideration of vedolizumab may optimise patient outcomes and minimise complications.
• Treatment choice should favour vedolizumab for newly diagnosed CD patients prior to multiple other biologics.

🔗 Source: PubMed | DOI

🧾 Perioperative Risk with Vedolizumab: What Surgery Teams Need to Know

✅ Do:

• Continue vedolizumab in the perioperative period for most IBD patients; no significant increase in overall surgical complications vs controls.
• Closely monitor for postoperative ileus, as vedolizumab has higher risk than infliximab (RR = 2.29, 95% CI: 1.59-3.29).

⚠️ With caution:

• Be alert for inflammatory complications but note no increased risk for surgical site infections or anastomotic leak compared to other biologics.

🚫 Avoid:

• Discontinuing vedolizumab without clear evidence, as current guideline update (UEG & partners, 2025) finds no consensus for or against perioperative withdrawal.

🔗 Source: PubMed | DOI

PubMed - Guideline update | DOI

❓ Practice question: Does vedolizumab increase TB risk in IBD patients in low-incidence regions?

✅ Study answer: In a US cohort (n=20,705), TB incidence with vedolizumab/other non-TNF biologics (IR 33/100,000 PY) was comparable and very low versus TNF antagonists (IR 38/100,000 PY); adjusted HR 1.16 (0.41–3.31).

📍 How to apply:

• No increased TB risk with vedolizumab in US/low-incidence settings versus other advanced therapies; routine screening remains recommended, but escalation to vedolizumab need not be limited due to TB concerns.

🔗 Source: PubMed | DOI