🫀 Comparative efficacy of advanced maintenance therapies in Crohn’s: new NMA insights
🧪 What was studied — Systematic review and network meta-analysis (9 RCTs) comparing maintenance treatments for moderate-to-severe Crohn’s disease (IV/SC vedolizumab, infliximab, adalimumab, ustekinumab, risankizumab, upadacitinib) over 48–64 weeks in adults. Primary endpoints: clinical remission and endoscopic response, stratified by line of therapy.
📈 Key results — Subcutaneous infliximab 120 mg q2w displayed the highest numerical efficacy for clinical remission (RD vs. placebo: up to 0.51) and endoscopic response. However, no statistically significant differences were found between therapies. Serious adverse event rates were similar across all drugs, including vedolizumab.
📍 What this changes in practice —
- No single advanced therapy clearly outperforms others for maintenance: personalise therapy based on patient context and drug characteristics.
- Vedolizumab shows comparable safety with other options.
- Decision-making should integrate real-world needs and preferences, not just efficacy numerics.
🔗 Source — PubMed | Publisher
❓ Is vedolizumab TDM helpful for Crohn’s disease remission assessment?
✅ Study answer — In this retrospective observational study (n=70, CD patients on vedolizumab maintenance), higher median trough levels were seen in clinical remission (17.5 vs. 13.4 μg/mL; p=0.07), but this was not statistically significant and did not predict remission individually. No cutoff reliably predicted outcomes; ROC AUC for clinical remission was 0.647.
📍 How to apply —
- Routine vedolizumab TDM alone is not a strong predictor of remission during maintenance in CD.
- Consider individual factors (SC vs IV, albumin, CRP, FCP) for interpreting trough concentrations.
- Use TDM contextually, not as a sole decision driver—especially in maintenance settings.
🔗 Source — PubMed | Publisher
🧾 Monitoring endoscopic recurrence after Crohn’s surgery—role for faecal calprotectin
✅ Do
- Use faecal calprotectin (FC) after treatment escalation for endoscopic recurrence:
- FC <250 μg/g pre-endoscopy: high specificity (100%) for endoscopic improvement in patients with baseline FC >200 μg/g.
⚠️ With caution
- Small single-centre series (n=22)—results need external validation.
- Always correlate with clinical context and mucosal findings.
🚫 Avoid
- Relying solely on FC values where baseline FC is <200 μg/g or in the absence of follow-up endoscopy.
🔗 Source — PubMed | Publisher
|
