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Maintenance of remission among patients with inflammatory bowel disease after vedolizumab discontinuation: a multicentre cohort study

Antoine Martin 1 Maria Nachury 2 Laurent Peyrin-Biroulet 3 Yoram Bouhnik 4 Stephane Nancey 5 Anne Bourrier 6 Mélanie Serrero 7 Mathurin Fumery 8 Anthony Buisson 9 David Laharie 10 Cyrielle Gilletta 11 Jérome Filippi 12 Matthieu Allez 13 Guillaume Bouguen 14, 15 Xavier Roblin 16 Romain Altwegg 17 Nina Dib 18 Guillaume Pineton de Chambrun 17 Guillaume Savoye 19, 20, 21, 22 Franck Carbonnel 23 Stephanie Viennot 24 Aurélien Amiot 25
Abstract : Background and aim - It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. Methods - This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. Results - A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 [5.8-17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33-0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21-0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. Conclusions - In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.
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Antoine Martin, Maria Nachury, Laurent Peyrin-Biroulet, Yoram Bouhnik, Stephane Nancey, et al.. Maintenance of remission among patients with inflammatory bowel disease after vedolizumab discontinuation: a multicentre cohort study. Journal of Crohn's & Colitis, Oxford University Press 2020, 14 (7), pp.896-903. ⟨10.1093/ecco-jcc/jjaa005⟩. ⟨hal-02442530⟩

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