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Vedolizumab for perianal Crohn’s disease: a multicentre cohort study in 151 patients
Author(s) -
ChapuisBiron Constance,
Bourrier Anne,
Nachury Maria,
Nancey Stéphane,
Bouhnik Yoram,
Serrero Mélanie,
ArmengolDebeir Laura,
Buisson Anthony,
TranMinh MyLinh,
Zallot Camille,
Fumery Mathurin,
Bouguen Guillaume,
Abitbol Vered,
Viennot Stéphanie,
Chanteloup Elise,
Rajca Sylvie,
Dib Nina,
Parmentier AnneLaure,
PeyrinBiroulet Laurent,
Vuitton Lucine
Publication year - 2020
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15665
Subject(s) - medicine , vedolizumab , crohn's disease , cohort , cohort study , surgery , disease , odds ratio
Summary Background The management of Crohn's disease patients with perianal lesions and anti‐TNF failure is challenging. Aims To assess the effectiveness of vedolizumab in perianal Crohn's disease and the predictors of success in a real‐life cohort. Methods We conducted a nationwide multicentre cohort study in patients with perianal Crohn's disease who received vedolizumab. In patients with active perianal Crohn's disease, the success of vedolizumab was defined by clinical success (no draining fistula at clinical examination and no anal ulcers for primary lesions) at 6 months without medical or surgical treatment for perianal Crohn's disease. Logistic regression analyses were performed to identify predictors of success. In patients with inactive perianal Crohn's disease, recurrence was defined by the occurrence of lesions and/or the need for medical or surgical treatments. Results One hundred and fifty‐one patients were included. Among them 102 patients had active perianal disease, 33 (32.4%) males, mean age 39.8 years, mean Crohn's disease duration 14.6 years; 101 (99%) had received at least one anti‐TNF. The median follow‐up time was 52 weeks. Sixty‐eight per cent of patients discontinued therapy after a median time of 33 weeks. Vedolizumab success was reached in 23/102 (22.5%). Among patients with setons at initiation, 9/61(15%) had a successful removal. In multivariable analysis, factors associated with success were the number of prior biologic agents (≥3, odds ratio, OR: 0.20, 95% CI 0.04‐0.98) and no antibiotics at initiation (OR: 4.76, 95% CI 1.25‐18.19). In 49 patients with inactive perianal Crohn's disease, perianal disease recurred in 15/49 (30.6%), 11/49 (22.4%) needed dedicated treatments. Median time to recurrence was 22 weeks. Conclusions We identified a low rate of success of vedolizumab in patients with active perianal Crohn's disease, and nearly one third of patients with inactive perianal Crohn's disease had perianal recurrence. Further evaluation is warranted in prospective studies.