Clinical response of vedolizumab at week 6 predicted endoscopic remission at week 24 in ulcerative colitis

Vedolizumab is a humanized monoclonal antibody that selectively inhibits the migration of gut-homing memory T cells into the intestinal submucosa by antagonizing the interaction of α₄β₇ integrin with MAdCAM-1. Vedolizumab is employed for ulcerative colitis with moderate to severe activity; however, predictors of its clinical efficacy have not been established in real-world clinical practice. We investigated the clinical characteristics predicting vedolizumab efficacy.

This was a single-center, retrospective, observational study that enrolled patients with ulcerative colitis at Kyorin University Hospital. Fifty-two consecutive patients who started vedolizumab induction therapy and were tracked for minimum 14 weeks between August 2018 and February 2021 were included. Clinical and endoscopic disease activities were scored at baseline and at weeks 2, 6, and 14 with the Lichtiger index and at baseline and week 24 with the Mayo endoscopic subscore, respectively. Clinical remission, clinical response, and endoscopic remission were defined as Lichtiger index of ≤3, Lichtiger index of ≤10 with a reduction of minimum 3 points from baseline, and Mayo endoscopic subscore of ≤1, respectively.

In these cases, clinical response/remission rates at weeks 2, 6, and 14 were 26.9%/15.3%, 50.0%/46.3%, and 57.6%/50.0%, respectively. The endoscopic remission rate at week 24 was 60%. The clinical response at week 6 was significantly associated with endoscopic remission at week 24 after starting vedolizumab.

In vedolizumab treatment for ulcerative colitis, the clinical response at week 6 can be a predictor for endoscopic remission at week 24.