Vedolizumab Trough Levels and Histological Healing During Maintenance Therapy in Ulcerative Colitis

Lieven Pouillon, Hélène Rousseau, Hélène Busby-Venner, Marcelo De Carvalho Bittencourt, Myriam Choukour, Guillaume Gauchotte, Camille Zallot, Silvio Danese, Cédric Baumann, Laurent Peyrin-Biroulet

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND AIMS: Histological healing may be the ultimate therapeutic goal in ulcerative colitis [UC]. We investigated, for the first time, the association between vedolizumab trough levels and histological healing in UC.

METHODS: This is a single-centre retrospective cohort study including all consecutive UC patients on vedolizumab maintenance therapy who had a histological evaluation blindly to clinical data and underwent therapeutic drug monitoring, between June 2014 and March 2018. Per-event analysis was performed. Histological healing was defined as a Nancy histological index ≤1.

RESULTS: Thirty-five histological samples were analysed. Median [interquartile range] vedolizumab trough levels were higher in the group with histological healing (31.5 [25-49.1] μg/mL) compared with the group without histological healing (15 [9-26.6] μg/mL, p = 0.02). The higher vedolizumab trough level quartiles tended to be associated with greater rates of histological healing [p = 0.10]. A cut-off vedolizumab trough level of 25 μg/mL predicted histological healing with an accuracy of 74% and an area under the receiver operating curve of 0.62 [95% confidence interval 0.58-0.92, p = 0.004]. Bivariate analysis identified a vedolizumab trough level ≥25 µg/mL [p = 0.006], a partial Mayo score ≤1 [p = 0.008], C-reactive protein level <5 mg/L [p = 0.005] and a Mayo endoscopic subscore ≤1 [p = 0.0004] as factors associated with histological healing.

CONCLUSIONS: Histological healing was associated with higher vedolizumab trough levels during maintenance therapy in UC. A vedolizumab trough level threshold of 25 μg/mL proved most optimal to predict histological healing according to the Nancy histological index. Confirmation of these data in larger, independent cohorts is needed.

Original languageEnglish
Pages (from-to)970-975
Number of pages6
JournalJournal of Crohn's & colitis
Volume13
Issue number8
DOIs
Publication statusPublished - Aug 14 2019

Keywords

  • Adult
  • Antibodies, Monoclonal, Humanized/administration & dosage
  • Biopsy/methods
  • Colitis, Ulcerative/blood
  • Colonoscopy/methods
  • Drug Monitoring/methods
  • Female
  • France/epidemiology
  • Gastrointestinal Agents/administration & dosage
  • Humans
  • Intestinal Mucosa/pathology
  • Maintenance Chemotherapy/methods
  • Male
  • Middle Aged
  • Retrospective Studies

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