Vedolizumab for the Treatment of Chronic Pouchitis.
Adult
Humans
Antibodies, Monoclonal, Humanized
/ administration & dosage
Ciprofloxacin
/ administration & dosage
Colitis, Ulcerative
/ complications
Pouchitis
/ drug therapy
Chronic Disease
Gastrointestinal Agents
/ administration & dosage
Proctocolectomy, Restorative
/ adverse effects
Double-Blind Method
Anti-Bacterial Agents
/ administration & dosage
Administration, Intravenous
Drug Therapy, Combination
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
30 Mar 2023
30 Mar 2023
Historique:
medline:
31
3
2023
entrez:
29
3
2023
pubmed:
30
3
2023
Statut:
ppublish
Résumé
Approximately half the patients with ulcerative colitis who undergo restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) will subsequently have pouchitis, and among those patients, one fifth will have chronic pouchitis. We conducted a phase 4, double-blind, randomized trial to evaluate vedolizumab in adult patients in whom chronic pouchitis had developed after undergoing IPAA for ulcerative colitis. Patients were assigned (in a 1:1 ratio) to receive vedolizumab intravenously at a dose of 300 mg or placebo on day 1 and at weeks 2, 6, 14, 22, and 30. All the patients received concomitant ciprofloxacin from weeks 1 to 4. The primary end point was modified Pouchitis Disease Activity Index (mPDAI)-defined remission (an mPDAI score of ≤4 and a reduction from baseline of ≥2 points in the mPDAI total score; scores range from 0 to 12, with higher scores indicating more severe pouchitis) at week 14. The mPDAI is based on clinical symptoms and endoscopic findings. Other efficacy end points included mPDAI-defined remission at week 34, mPDAI-defined response (a reduction from baseline of ≥2 points in the mPDAI score) at weeks 14 and 34, and PDAI-defined remission (a PDAI score of ≤6 and a reduction from baseline of ≥3 points; scores range from 0 to 18, with higher scores indicating more severe pouchitis) at weeks 14 and 34. The PDAI is based on clinical symptoms, endoscopic findings, and histologic findings. Among the 102 patients who underwent randomization, the incidence of mPDAI-defined remission at week 14 was 31% (16 of 51 patients) with vedolizumab and 10% (5 of 51 patients) with placebo (difference, 21 percentage points; 95% confidence interval [CI], 5 to 38; P = 0.01). Differences in favor of vedolizumab over placebo were also seen with respect to mPDAI-defined remission at week 34 (difference, 17 percentage points; 95% CI, 0 to 35), mPDAI-defined response at week 14 (difference, 30 percentage points; 95% CI, 8 to 48) and at week 34 (difference, 22 percentage points; 95% CI, 2 to 40), and PDAI-defined remission at week 14 (difference, 25 percentage points; 95% CI, 8 to 41) and at week 34 (difference, 19 percentage points; 95% CI, 2 to 37). Serious adverse events occurred in 3 of 51 patients (6%) in the vedolizumab group and in 4 of 51 patients (8%) in the placebo group. Treatment with vedolizumab was more effective than placebo in inducing remission in patients who had chronic pouchitis after undergoing IPAA for ulcerative colitis. (Funded by Takeda; EARNEST ClinicalTrials.gov number, NCT02790138; EudraCT number, 2015-003472-78.).
Sections du résumé
BACKGROUND
BACKGROUND
Approximately half the patients with ulcerative colitis who undergo restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) will subsequently have pouchitis, and among those patients, one fifth will have chronic pouchitis.
METHODS
METHODS
We conducted a phase 4, double-blind, randomized trial to evaluate vedolizumab in adult patients in whom chronic pouchitis had developed after undergoing IPAA for ulcerative colitis. Patients were assigned (in a 1:1 ratio) to receive vedolizumab intravenously at a dose of 300 mg or placebo on day 1 and at weeks 2, 6, 14, 22, and 30. All the patients received concomitant ciprofloxacin from weeks 1 to 4. The primary end point was modified Pouchitis Disease Activity Index (mPDAI)-defined remission (an mPDAI score of ≤4 and a reduction from baseline of ≥2 points in the mPDAI total score; scores range from 0 to 12, with higher scores indicating more severe pouchitis) at week 14. The mPDAI is based on clinical symptoms and endoscopic findings. Other efficacy end points included mPDAI-defined remission at week 34, mPDAI-defined response (a reduction from baseline of ≥2 points in the mPDAI score) at weeks 14 and 34, and PDAI-defined remission (a PDAI score of ≤6 and a reduction from baseline of ≥3 points; scores range from 0 to 18, with higher scores indicating more severe pouchitis) at weeks 14 and 34. The PDAI is based on clinical symptoms, endoscopic findings, and histologic findings.
RESULTS
RESULTS
Among the 102 patients who underwent randomization, the incidence of mPDAI-defined remission at week 14 was 31% (16 of 51 patients) with vedolizumab and 10% (5 of 51 patients) with placebo (difference, 21 percentage points; 95% confidence interval [CI], 5 to 38; P = 0.01). Differences in favor of vedolizumab over placebo were also seen with respect to mPDAI-defined remission at week 34 (difference, 17 percentage points; 95% CI, 0 to 35), mPDAI-defined response at week 14 (difference, 30 percentage points; 95% CI, 8 to 48) and at week 34 (difference, 22 percentage points; 95% CI, 2 to 40), and PDAI-defined remission at week 14 (difference, 25 percentage points; 95% CI, 8 to 41) and at week 34 (difference, 19 percentage points; 95% CI, 2 to 37). Serious adverse events occurred in 3 of 51 patients (6%) in the vedolizumab group and in 4 of 51 patients (8%) in the placebo group.
CONCLUSIONS
CONCLUSIONS
Treatment with vedolizumab was more effective than placebo in inducing remission in patients who had chronic pouchitis after undergoing IPAA for ulcerative colitis. (Funded by Takeda; EARNEST ClinicalTrials.gov number, NCT02790138; EudraCT number, 2015-003472-78.).
Identifiants
pubmed: 36988594
doi: 10.1056/NEJMoa2208450
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Ciprofloxacin
5E8K9I0O4U
vedolizumab
9RV78Q2002
Gastrointestinal Agents
0
Anti-Bacterial Agents
0
Banques de données
ClinicalTrials.gov
['NCT02790138']
EudraCT
['2015-003472-78']
Types de publication
Clinical Trial, Phase IV
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1191-1200Investigateurs
Marc Ferrante
(M)
Brian Bressler
(B)
Mark Silverberg
(M)
Richmond Sy
(R)
Cyrielle Gilletta de Saint Joseph
(C)
Laurent Peyrin-Biroulet
(L)
Laurent Siproudhis
(L)
Daniel Baumgart
(D)
Andreas Fischer
(A)
Tanja Kuehbacher
(T)
Andreas Stallmach
(A)
Alessandro Armuzzi
(A)
Silvio Danese
(S)
Paolo Gionchetti
(P)
Edoardo Savarino
(E)
Mark Löwenberg
(M)
Marie Pierik
(M)
Guillermo Bastida Paz
(G)
Ailsa Hart
(A)
Gareth Parkes
(G)
Simon Travis
(S)
Dawn Beaulieu
(D)
Robin Dalal
(R)
Sushila Dalal
(S)
John Hanson
(J)
Hans Herfarth
(H)
Darrell Pardi
(D)
Jessica Philpott
(J)
Timothy Ritter
(T)
Bo Shen
(B)
John Valentine
(J)
Byron Vaughn
(B)
Eugene Yen
(E)
Informations de copyright
Copyright © 2023 Massachusetts Medical Society.