Influencing factors for secondary loss of response to vedolizumab in ulcerative colitis
10.3760/cma.j.cn101480-20231104-00057
- VernacularTitle:溃疡性结肠炎对维得利珠单克隆抗体继发性失应答的影响因素分析
- Author:
Ying XIE
1
;
Fan ZHOU
1
;
Chunyan PENG
1
;
Xiaoqi ZHANG
1
Author Information
1. 南京大学医学院附属鼓楼医院消化内科，南京 210008
- Publication Type:Journal Article
- Keywords:
Ulcerative colitis;
Vedolizumab;
Secondary loss of response;
Endoscopic remission
- From:
Chinese Journal of Inflammatory Bowel Diseases
2024;08(3):205-210
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the influencing factors of secondary loss of response (SLR) in ulcerative colitis (UC) patients treated with vedolizumab (VDZ) .Methods:A retrospective cohort study was conducted. The patients with moderate UC who initiated VDZ treatment from November 2020 to October 2022 at Drum Tower Hospital of Nanjing University Medical College were included consecutively. They received VDZ treatment for at least 4 times and achieved clinical response at (22 ± 4) th week, and then were divided into the lost response group and sustained response group based on whether SLR occurred during follow-up period. Differences in clinical data between the two groups were compared, and influencing factors of SLR were analyzed by using univariate and multivariate Cox regression models. Kaplan-Meier curves were used to analyze the sustained clinical response.Results:A total of 40 UC patients were enrolled, including 21 males and 19 females. The average age of medication was (43.8 ± 15.5) years, with a disease course of 3.3 (2.0, 8.0) years. The extent was mainly E3 extensive UC type (62.5%) and modified Mayo score was 7 (6, 8) points. There were 17 patients (42.5%) using glucocorticoids and 35 patients (87.5%) using 5-aminosalicylic acid in combination of VDZ. A total of 29 patients completed endoscopic evaluation at (22 ± 4) th week, with a total endoscopic remission rate of 75.9% (22/29) . SLR occurred in 12 patients who were set as lost response group and the remaining 28 as sustained response group. The mean time from starting VDZ therapy to SLR occurrence was (11.9 ± 5.9) months. The endoscopic remission rates were 42.9% (3/7) in lost response group and 86.4% (19/22) in sustained response group and there was significant difference between the two groups (χ 2 = 5.489, P = 0.038) . Univariate and multivariate Cox regression analyses showed that endoscopic remission at (22 ± 4) th week was an independent protective factor against SLR ( HR = 2.71, 95% CI: 1.30-5.62, P = 0.008) . Kaplan-Meier survival curve demonstrated that patients who did not achieve endoscopic remission at (22 ± 4) th week were more likely to experience SLR ( OR = 2.71, 95% CI: 1.30-5.62, P = 0.042) . Among the 17 patients who received concomitant corticosteroids, 16 (94.1%) achieved steroid-free remission. In the lost response group, the rate of regaining response was 41.7% (5/12) through optimization of treatment and combination with corticosteroids. Eight patients (20%) experienced adverse reactions during the treatment. Conclusion:For moderate UC patients treated with VDZ, the higher endoscopic remission rate at (22 ± 4) th week, the lower incidence of SLR.
