🫀 Vedolizumab reduces endoscopic relapse post-Crohn’s surgery: Moderate-certainty RCT meta-analysis

🧪 What was studied — Systematic review and network meta-analysis of 34 RCTs (n=3197) comparing maintenance therapies after surgically induced Crohn’s disease (CD) remission. Treatments included vedolizumab, adalimumab, 5-ASA, purines, and others. Evaluated outcomes: clinical relapse, endoscopic relapse, adverse event withdrawals.

📈 Key results — Vedolizumab probably reduces endoscopic relapse (RR 0.37, 95% CI 0.17–0.80; moderate certainty, large effect size). Adalimumab reduces both clinical (RR 0.31, moderate certainty) and endoscopic relapse (RR 0.47, low certainty). 5-ASA and purines: only trivial benefit. No other therapies showed convincing benefit.

📍 What this changes in practice — For postoperative CD, vedolizumab is a strong candidate for maintenance to prevent endoscopic recurrence, especially when adalimumab may not be preferred. Choose based on patient risk and prior biologic exposure.

🔗 Source — PubMed | DOI

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🫀 Real-world data: Vedolizumab’s long-term effectiveness and predictors in Japanese UC patients

🔥 Main in 3 points

• 52-week mucosal healing with vedolizumab in Japanese UC: 52.3%.
• Prior anti-TNF failure impacts outcomes: secondary loss of response fares better than primary non-response.
• Early week-6 clinical response predicts 1-year remission (OR 14.5, p<0.01).

🧪 Context — Multicentre retrospective cohort, 172 patients with UC, 2018–2022; assessed persistence, response/remission, safety, and prognostic factors over 156 weeks.

📍 Practical significance — Early assessment at week 6 can guide long-term prognosis and decision-making. Consider vedolizumab regardless of prior anti-TNF, but recognize diminished efficacy in primary non-responders. Safety was favorable (6 AEs; no severe events).

🔗 Source — PubMed | DOI

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⚠️ Biologic selection & enteric infection risk: Vedolizumab and Ustekinumab not linked to increased CDI, CI, or CMV

🧪 Context — Single-centre, retrospective Asian cohort (n=614 IBD; 941 patient-years), comparing vedolizumab, anti-TNF, and ustekinumab for risk of Clostridioides difficile infection (CDI), C. innocuum, and CMV colitis.

📊 Numbers — Per 100 patient-years: CDI 3.51, C. innocuum 0.85, CMV colitis 3.30. CMV colitis rate highest with anti-TNF (5.9%) compared to vedolizumab (3.4%) or ustekinumab (0.5%), p=0.020.

📍 Actions — Vedolizumab and ustekinumab are not associated with excess enteric infection burden in this population. For patients at risk (acute flare, prior CMV or CI infection), increase vigilance regardless of therapy.

🔗 Source — PubMed | DOI

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