P378 Mucosal healing is achieved in most of the inflammatory bowel disease patients in clinical remission with vedolizumab: a real-life single-centre experience
M.I. Calvo Moya1, I. Omella Usieto1, M.I. Vera Mendoza1, V. Matallana Royo1, I. Gonzalez Partida1, M. Manso Manrique2, B. Menchén Viso2, R. De Lucas Téllez de Meneses1, M. González Rodriguez1, P. Bella del Castillo1, Y. González Lama1
1Gastroenterology and Hepatology Department, IBD Unit, Hospital Universitario Puerta de Hierro - Majadahonda, Majadahonda Madrid, Spain, 2Pharmacy Department, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
Background
Current therapeutic goals in inflammatory bowel disease (IBD) include not only the mere absence of symptoms but also the resolution of endoscopic lesions, so-called mucosal healing (MH), which has been related to better outcomes. Data regarding the achievement of MH with vedolizumab (VDZ) in real-life clinical practice is still scarce.
Methods
Retrospective cohort study was carried out in a tertiary hospital between January 2015 and April 2019 including patients with a basal colonoscopy showing activity and who achieved clinical remission under treatment with VDZ, defined by partial Mayo score <2 for ulcerative colitis (UC) and Harvey–Bradshaw Index score (HBI) <4 for Crohn’s disease (CD). Surveillance colonoscopy was performed along with the follow-up according to clinical practice. In UC patients, MH was defined as Mayo Endoscopic Subscore (MES) = 0; the endoscopic response was defined by a decrease in MES ≥1 point. In CD, MH was defined by achievement SES-CD = 0–3 or Rutgeerts index i0; the endoscopic response was defined by a decrease of SES-CD of 50% or Rutgeerts index <i2 with at least 1 point of decease compared with baseline.
Results
In total, 118 patients treated with VDZ were analysed, but only 45 met inclusion criteria with a median follow-up of 21 (IQR: 14–19) months. Surveillance colonoscopy was performed after a median time of 12 months (IQR:9–17) of treatment. MH achieved in 33/45 patients (73%): 17/23 CD patients (74%) and 16/22 UC patients (73%). The endoscopic response was achieved in 9 of the remaining 12 patients: 3/6 CD patients and 6/6 UC patients. Only 3 (7%) of patients included showed no endoscopic benefit at the time of surveillance endoscopy. In multivariate analysis, probability of not achieving MH was 75% in patients previously treated with immunosuppressants (ISS) (HR 0.25, 0.11–0.55 IC95;
| Female, | 22 (49%) |
| Median disease duration before VDZ, years (IQR) | 7 (4–11) |
| Previous ISS and biologic therapy, | 32 (71) 32 (71) |
| Biological treatment failure, | 14 (31) 13 (29) 18 (40) |
| Concomitant ISS therapy, | 14 (31) |
| Corticosteroid use at induction, | 16 (36) |
| Severe endoscopic baseline lesions, | 8 (35) 15 (68) |
Conclusion
In our experience, most of the patients who achieve clinical remission with VDZ also achieve MH. Refractory patients were less likely to achieve MH despite having achieved clinical remission.