🫀 Vedolizumab Shows Real-World Effectiveness in Chronic Antibiotic-Refractory Pouchitis, Including IV to SC Switch

🔥 Main in 3 points

• Vedolizumab significantly improved disease activity scores and reduced fecal calprotectin through 52 weeks in chronic antibiotic-refractory pouchitis (CARP) patients.
• Transitioning from IV to SC vedolizumab maintained or improved mPDAI and biomarker outcomes, alongside higher serum drug levels.
• Safety profile was favorable; prior use of immunosuppressants, corticosteroids, or VDZ before IPAA did not negatively impact response.

🧪 Context

Multicenter Spanish RWE study (n=47) in CARP with mPDAI and fecal calprotectin assessments at weeks 12, 24, 52; 53% transitioned to SC VDZ.

📍 Practical significance

Use vedolizumab early for CARP to maximise disease control. Switching stable patients to SC VDZ is effective and safe, with comparable adverse event rates to IV. More prior lines of therapy may reduce response rate—consider VDZ earlier in the sequence.

🔗 Source — PubMed | DOI

🧪 Treat-to-Target Biologic Optimization: Endoscopy-Guided Approach Achieves Deep Remission in UC

🧪 What was studied

Retrospective study (TACTIC-UC; n=142, 164 episodes) in UC with mild symptoms but moderate/severe endoscopic disease. Endoscopy-guided optimization of anti-TNF, vedolizumab, or ustekinumab. Primary outcome: mucosal healing at 1 year.

📈 Key results

• 54.2% achieved mucosal healing, 28.8% full endoscopic remission, 20.9% histo-endoscopic remission at 1 year.
• Non-anti-TNF biologics (including vedolizumab) induced meaningful but somewhat lower rates than anti-TNFs, but outcomes still substantial.
• No new safety signals.

📍 What this changes in practice

Do not wait for symptoms in UC with active endoscopy—proactively optimize biologics, including vedolizumab, using endoscopic findings. Treat-to-target strategies deepen mucosal healing and improve treatment longevity.

🔗 Source — PubMed | DOI

✅ Model-Informed Dosing of Vedolizumab in IBD: MOVE-IT RCT Protocol

❓ Practice question

Does model-informed precision dosing (MIPD) with PK-guided adjustments for vedolizumab/ustekinumab outperform or match symptom/biomarker-based management in IBD?

✅ Study answer

MOVE-IT, a randomised controlled trial (n=166, Denmark), will randomize IBD patients (UC/CD, ≥3 months on stable VDZ or UST) to MIPD or typical symptom/biomarker-driven dosing. Primary endpoint: steroid-free remission. Secondary: mucosal healing, cost-effectiveness.

📍 How to apply

Results (pending) could validate routine PK-guided dosing for vedolizumab in clinical practice, optimising patient outcomes and potentially reducing unnecessary dose escalations or costs.

🔗 Source — PubMed | DOI