🫀 Vedolizumab More Effective and Safer in Early Crohn's Disease Compared to Late Disease
🧪 What was studied: The LOVE-CD phase 4 open-label cohort study investigated vedolizumab in adults with moderate-to-severe Crohn's disease across 22 European centres. Patients were stratified as early (diagnosis <2 years, fewer prior advanced therapies) or late (diagnosis >2 years, prior steroids, immunomodulators, anti-TNF). Vedolizumab was given for 52 weeks, with primary outcome being clinical and endoscopic remission (CDAI ≤150; SES-CD <4) at weeks 26 and 52.
📈 Key results: Remission was achieved in 31.4% (27/86) of early CD patients vs 8.6% (15/174) of late CD (difference 22.8%, 95% CI 12.6–33.7). Serious adverse events were lower in early CD (3.5%) than late CD (26.4%), including infections and need for surgery.
📍 What this changes in practice:
- Vedolizumab achieves higher remission and better safety in early, biologic-naive Crohn's disease.
- Early consideration of vedolizumab may optimise patient outcomes and minimise complications.
- Treatment choice should favour vedolizumab for newly diagnosed CD patients prior to multiple other biologics.
🔗 Source: PubMed | DOI
🧾 Perioperative Risk with Vedolizumab: What Surgery Teams Need to Know
✅ Do:
- Continue vedolizumab in the perioperative period for most IBD patients; no significant increase in overall surgical complications vs controls.
- Closely monitor for postoperative ileus, as vedolizumab has higher risk than infliximab (RR = 2.29, 95% CI: 1.59-3.29).
⚠️ With caution:
- Be alert for inflammatory complications but note no increased risk for surgical site infections or anastomotic leak compared to other biologics.
🚫 Avoid:
- Discontinuing vedolizumab without clear evidence, as current guideline update (UEG & partners, 2025) finds no consensus for or against perioperative withdrawal.
🔗 Source: PubMed | DOI
PubMed - Guideline update | DOI
❓ Practice question: Does vedolizumab increase TB risk in IBD patients in low-incidence regions?
✅ Study answer: In a US cohort (n=20,705), TB incidence with vedolizumab/other non-TNF biologics (IR 33/100,000 PY) was comparable and very low versus TNF antagonists (IR 38/100,000 PY); adjusted HR 1.16 (0.41–3.31).
📍 How to apply:
- No increased TB risk with vedolizumab in US/low-incidence settings versus other advanced therapies; routine screening remains recommended, but escalation to vedolizumab need not be limited due to TB concerns.
🔗 Source: PubMed | DOI
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