🫀 Vedolizumab in Paediatric IBD: Impact on Extraintestinal Manifestations

🔥 Main in 3 points

• In a prospective multicenter cohort (VedoKids), vedolizumab was associated with resolution of 89% of extraintestinal manifestations (EIMs) within 18 months in children with IBD.
• Nearly half of EIM cases were treated with concomitant medications at VDZ start; however, new EIMs were rare (4%) during follow-up.
• The presence of EIMs at baseline did not negatively impact the durability of vedolizumab therapy.

🧪 Context

Subgroup analysis from the VedoKids cohort (n=142 children, 0–18 yrs) with IBD on vedolizumab up to week 54. Studied rates/resolution of EIMs and vedolizumab persistence.

📍 Practical significance

For paediatric IBD patients with EIMs, vedolizumab can lead to high EIM resolution rates and does not appear to compromise treatment persistence. Consider continued monitoring, particularly for articular and cutaneous EIMs, and remember that concomitant therapy may be needed for some.

🔗 Source — PubMed | DOI

🧪 Machine Learning Identifies Predictors of Biologic Response in IBD

🧑‍⚕️ What was studied

Real-world, single-centre cohort (n=227, 2015–2022) using XGBoost machine learning to model predictors of response/remission to vedolizumab and ustekinumab at 26 and 52 weeks in IBD (Crohn’s, UC). Key variables: clinical, demographic, and lab data.

📈 Key results

Models showed strong discriminatory performance (F1 0.84–0.87, accuracy up to 0.91). Major predictors: leukocyte count, faecal calprotectin (FCP), CRP, and vitamin B12—higher inflammatory markers linked to poorer outcomes. Model generalisability limited by small subgroups.

📍 What this changes in practice

Integrating clinical and biochemical markers enhances biologic response prediction. Prioritise comprehensive lab/demographic data collection to inform personalised IBD therapy, noting that higher inflammation at baseline remains prognostically adverse.

🔗 Source — PubMed | DOI

🧾 Vedolizumab as Second-Line in Cronkhite-Canada Syndrome

✅ Do

• Consider vedolizumab after infliximab loss-of-response in rare polyposis syndromes like Cronkhite-Canada, especially where initial anti-TNF success is followed by failure.
• Monitor clinical and endoscopic remission as endpoints.

⚠️ With caution

• Recognise that data is limited to case reports; decisions should be highly individualized.
• Continue standard surveillance for disease activity and therapy side effects.

🔗 Source — PubMed | DOI