🫀 Thromboembolic and Cardiovascular Risk in UC on Advanced Therapy: Vedolizumab Data
🔥 Main in 3 points
- Vedolizumab users with ulcerative colitis had a lower risk of venous thromboembolism (VTE) and cardiovascular events (CVEs) than those on TNF inhibitors.
- Tofacitinib (5mg/10mg BID) showed no significant VTE/CVE signal compared to TNF inhibitors; 5-ASA use reduced VTE risk.
- Major adverse cardiovascular event (MACE) rates were similar across advanced therapies.
🧪 Context
Retrospective cohort, Japanese claims data; 8125 TNFi, 2469 vedolizumab, 1218 tofacitinib users evaluated for VTEs, CVEs, MACEs after therapy initiation.
📍 Practical significance
In ulcerative colitis patients needing advanced therapy, vedolizumab appears particularly suitable when cardiovascular/thrombotic risk is a concern. 5-ASA co-use may further reduce VTE risk. Consider cardiovascular profile alongside efficacy when selecting biologics.
🔗 Source — PubMed | DOI
❓ Does switching UC/CD patients to a second TNFi increase risk for de-novo immune-mediated inflammatory diseases compared to switching to vedolizumab/ustekinumab?
✅ Study answer
In a matched real-world cohort (n=14,360), switching to a second TNFi resulted in a significantly higher incidence of new-onset IMIDs (10.8% vs 6.9%; adjusted HR 1.57, 95% CI 1.37-1.79) versus those switched to vedolizumab or ustekinumab, for both ulcerative colitis and Crohn’s disease.
📍 How to apply
Consider vedolizumab or ustekinumab over a second TNFi for IBD patients with prior TNFi exposure—especially in patients at risk for additional IMIDs. Individualise therapy choice using comorbid risk profiles and prior history.
🔗 Source — PubMed | DOI
🧾 Predicting Vedolizumab Persistence in UC: Importance of Endoscopic Response at 24 Weeks
✅ Do
- Assess endoscopic response (Mayo subscore) at 24 weeks in all UC patients on vedolizumab.
- Prioritise maintenance strategies for those with early endoscopic improvement.
⚠️ With caution
- Co-administering immunomodulators or 5-ASA may not significantly change vedolizumab persistence outcomes.
🚫 Avoid
- Relying solely on clinical remission without endoscopic monitoring to predict long-term response.
🔗 Source — PubMed | DOI
|
