1. Vedolizumab Clinical Decision Support Tool Predicts Efficacy of Vedolizumab But Not Ustekinumab in Refractory Crohn's Disease
- Author
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Franck Carbonnel, Aurelien Amiot, Antoine Meyer, Yoram Bouhnik, Hadrien Alric, Mathieu Allez, Laurent Beaugerie, Xavier Treton, and Julien Kirchgesner
- Subjects
medicine.medical_specialty ,Antibodies, Monoclonal, Humanized ,Vedolizumab ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Crohn Disease ,Gastrointestinal Agents ,Internal medicine ,Ustekinumab ,medicine ,Immunology and Allergy ,Humans ,In patient ,030212 general & internal medicine ,Crohn's disease ,business.industry ,Remission Induction ,Gastroenterology ,Area under the curve ,University hospital ,medicine.disease ,Decision Support Systems, Clinical ,Treatment Outcome ,030211 gastroenterology & hepatology ,Tumor Necrosis Factor Inhibitors ,business ,medicine.drug - Abstract
Introduction Vedolizumab clinical decision support tool (VDZ-CDST) predicts response to vedolizumab, but whether this tool also predicts efficacy of other drugs in Crohn’s disease (CD) is unknown. This study aimed to assess the value of VDZ-CDST to predict vedolizumab and ustekinumab efficacy in patients with CD. Patients and methods We included consecutive CD patients refractory or intolerant to anti-TNF who started either vedolizumab or ustekinumab in 5 university hospitals between May 2014 and August 2018. The main end points were the rates of clinical remission and steroid-free clinical remission (SFCR) in each group of VDZ-CDST at week 48. Results One hundred eighty patients were included; 94 received vedolizumab (VDZ-CDST ≤13: 32; VDZ-CDST >13 and ≤19: 52; VDZ-CDST >19: 10), and 86 received ustekinumab (VDZ-CDST ≤13: 16; VDZ-CDST >13 and ≤19: 60; VDZ-CDST >19: 10). At week 48 in the vedolizumab group, clinical remission and SFCR were reached in 9.4% with a VDZ-CDST ≤13, in 38.5% and 28.8% with a VDZ-CDST >13 and ≤19, respectively, and in 80.0% with a VDZ-CDST >19 (P 13 and ≤19, and 50.0% with a VDZ-CDST >19, respectively (P = 0.65 and P = 0.46, respectively). VDZ-CDST identified SFCR with an area under the curve of 0.69 (95% CI, 0.57–0.82) for vedolizumab and 0.52 (95% CI, 0.40–0.65) for ustekinumab. Conclusion The VDZ-CDST predicts clinical remission and SFCR at week 48 for vedolizumab but not for ustekinumab in CD patients refractory or intolerant to anti-TNF.
- Published
- 2020