Vedolizumab use after failure of TNF-α antagonists in children and adolescents with inflammatory bowel disease

BMC Gastroenterology, 2018 · DOI: https://doi.org/10.1186/s12876-018-0868-x · Published: September 3, 2018

Simple Explanation

Vedolizumab is a medication used to treat adults with Crohn’s disease (CD) and ulcerative colitis (UC). This study looks at how well it works and how safe it is for children with inflammatory bowel disease (IBD). The study reviewed the cases of 12 children with severe IBD who were treated with vedolizumab after other medications (tumour necrosis factor α antagonist treatment) didn't work. The results suggest that vedolizumab can be effective for some children with IBD, especially those with UC, who haven't responded to other treatments. However, it may not work as well for children with CD.

Study Duration

At least 38 weeks

Participants

12 patients (7 CD; 5 UC), aged 8–17 years

Evidence Level

Not specified

Key Findings

1
In the UC group, complete clinical remission was achieved at weeks 2, 6, and 14 in 2/5, 1/5 and 1/5 patients respectively; partial response was observed in one patient at week 2.
2
CD activity scores did not significantly change from baseline to week 38 (median 47.5 vs. 40 points, p = 1,0), while median UC activity scores changed from 70 to 5 points (p < 0,001).
3
Substantial weight gain and increased albumin and haemoglobin levels were observed in both groups.

Research Summary

This study evaluates the use of vedolizumab in Austrian pediatric patients with IBD who had previously failed TNF-α antagonist treatment. The results suggest that vedolizumab can be an effective treatment for individual paediatric patients with IBD who are unresponsive, intolerant, or experience a loss of efficacy in other therapies. However, vedolizumab appears to be more effective in paediatric UC than in paediatric CD.

Practical Implications

Treatment Option

Vedolizumab may be considered as a treatment option for pediatric IBD patients who have failed TNF-α antagonists.

Disease Specificity

Vedolizumab appears to be more effective in pediatric UC compared to CD.

Further Research

Prospective long-term studies are needed to define the full safety profile and adequate dosing for vedolizumab treatment in children with IBD.

Study Limitations

1
The study was retrospective in nature.
2
The sample size was small.
3
It was not possible to include faecal calprotectin in the CD cohort and ESR values.

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