P677 Combination of vedolizumab and exclusive enteral nutrition in patients with moderate to severe Crohn’s Disease
Kang, J.(1,2,3);Wang, J.(1,2,3);Lu, Y.(4);Li, J.(1,2,3);Su, J.(1,2,3);Ying, A.(1,2,3);Ren, H.(1,2,3);Zhou, Q.(1,2,3);Wang, Y.(1,2,3);Ding, Y.(1,2,3);An, P.(1,2,3)*;
(1)Renmin Hospital of Wuhan University, Gastroenterology, Wuhan, China;(2)Renmin Hospital of Wuhan University, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Wuhan, China;(3)Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China;(4)Jingzhou First People's Hospital, Gastroenterology, Jingzhou, China;
Background
Crohn’s disease (CD) is an incurable chronic inflammatory condition of the gut. It causes severe gastrointestinal and extraintestinal complications and is associated with high morbidity, poor quality of life and increased health expenditure. Although increasing randomized controlled tests (RCT) studies demonstrated the premise of efficacy of biologics including vedolizumab in adult patients with active CD, there’re still 60% of patients hard to achieve clinical and endoscopic remission in real-world studies. Here, we investigated the efficacy of combination strategy of vedolizumab and exclusive enteral nutrition (EEN) in moderate to severe active CD treatment.
Methods
Twenty-eight patients with moderately to severely active CD patients treated with vedolizumab in IBD medical center of Renmin Hospital of Wuhan University in Hubei Province were retrospectively enrolled in this cohort. All patients received EEN for 16 weeks with concomitant vedolizumab standard induction. The clinical response, clinical remission, and fecal calprotectin (FC) normalization was evaluated in short- (week 16) and moderate-term (week 32 and 48). Endoscopic response and mucosal healing were assessed at week 16 and 48 (Figure 1).
Figure 1: Study design
Results
Following vedolizumab intravenous induction and 16-weeks EEN treatment, patients achieved 71.4% (20/28) of clinical remission, 73.1% (19/26) of endoscopic response and 71.4% (20/28) FC normalization at week 16. For moderate-term assessment at week 32, sustainable efficacy of current treatment induced 19/24 (79.2%) of clinical response, 15/24 (62.5%) of clinical remission and 16/24 (66.7%) of FC normalization. Clinical response (15/22, 68.2%) and mucosa healing (14/22, 63.6%) were also observed in over 60% of patients at week 48 since treatment induction (Figure 2,3).
Figure 2. Clinical and biochemical endpoints
Figure 3. Endoscopic endpoint
Conclusion
Combination of Vedolizumab and 16-weeks EEN increased clinical and endoscopic outcomes in short and moderate term for patients with moderate to severe Crohn’s Disease.