P681 Efficacy of vedolizumab for the prevention of postoperative recurrence in Crohn’s disease: Data from clinical practice from the ENEIDA registry
M. Mañosa Ciria1, E. Hinojosa2, A. Carbajo3, J. Castro4, N. Manceñido5, M. Calvo6, A. Núñez Alonso7, J. P Gisbert8, P. Nos9, J. Guardiola10, E. Sainz11, E. Sánchez-Rodríguez12, F. Cañete1, M. Calafat1, E. Domènech1, Eneida Registry
1Hospital Universitari Germans Trias I Pujol, Department of Gastroenterology CIBERehd, IBD Unit, Badalona, Spain, 2Hospital de Manises, Gastroenterology, Manises, Spain, 3Hospital Rio Hortega, Gastroenterology, Valladolid, Spain, 4Hospital Clínic de Barcelona, Gastroenterology, Barcelona, Spain, 5Hospital Infanta Sofia, Gastroenterology, Madrid, Spain, 6Hospital Puerta de Hierro, Gastroenterology, Madrid, Spain, 7Hospital de Salamanca, Gastroenterology, Salamanca, Spain, 8Hospital La Princesa, Gastroenterology, Madrid, Spain, 9Hospital La Fe, Gastroenterology, Valencia, Spain, 10Hospital de Bellvitge, Gastroenterology, Barcelona, Spain, 11Althaia, Gastroenterology, Manresa, Spain, 12Hospital Ramon y Cajal, Gastroenterology, Madrid, Spain
Background
Anti-TNF and thiopurines are the only drugs that demonstrated efficacy in preventing postoperative recurrence (POR) in Crohn’s disease (CD). However, in some cases, these drugs are contraindicated or have previously failed. Vedolizumab was licensed for CD some years ago but scarce data on its efficacy for the prevention of POR is available.
Methods
All CD patients in whom vedolizumab was prescribed for primary prevention of POR within the first 3 months after ileocecal or ileocolonic resection with anastomosis were identified from the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD, GETECCU). We evaluated the rates of Endoscopic, clinical or surgical POR in the first 18 months. Endoscopic POR was defined by a Rutgeerts score >i1 and advanced endoscopic POR by >i2.
Results
Twenty-three patients were included; vedolizumab was started after a median time of 23 days (IIQ21-73). Concomitant immunosuppressants were used in 17%; 18% received an additional 3-month course of metronidazole after surgery. Regarding risk factors for POR: 13% were active smokers, 62% had prior resections, 33% had penetrating CD behaviour, and 22% had a history of perianal disease. Thirty-four per cent had been exposed to vedolizumab prior to the index surgery (26% within the last 6 months). The median time of follow-up on ustekinumab was 26 months (IQR 11–31). Eighty-three per cent of patients had at least one endoscopic assessment within 18 months after surgery: 40 % had endoscopic POR and 15% advanced endoscopic POR. Additionally, 22% presented clinical POR at the discretion of the treating physician and 9% developed surgical POR.
Conclusion
In a small clinical practice cohort, vedolizumab showed similar efficacy as that reported with anti-TNF in the prevention of endoscopic POR.