Conference Coverage

Vedolizumab Scores on Safety, Efficacy for Ulcerative Colitis

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'Impressive Results'

Vedolizumab is a biological therapy that blocks alpha-4/beta-7 integrins. This mechanism is novel within our arm­­­­a­­men­tarium of available therapies for ulcerative colitis, and vedo­lizumab is also the first non-sys­temically acting biologic therapy. The induction and maintenance results of this phase III trial of vedolizumab in moderate to severe ulcerative colitis are very encouraging and represent a major advance in our field. It appears that the impressive safety profile (infection rate was similar to placebo) seen in this trial is likely due to its gut-specific activity.

Furthermore, it is of interest that despite inhibition of lymphocyte trafficking in the gut, there does not appear to be an increased risk of GI infections. If these impressive results pan out in clinical practice, vedolizumab undoubtedly will become a significant option for the management of our ulcerative colitis patients, and will have a prominent place in our treatment algorithms. We eagerly await FDA review and further studies, including the Crohn’s disease trial results.

David T. Rubin, M.D., AGAF, is Professor of Medicine, Associate Section Chief for Education, and Co-Director, Inflammatory Bowel Disease Center, University of Chicago.


 

FROM THE ANNUAL DIGESTIVE DISEASE WEEK

The primary end point of the maintenance phase was clinical remission at 52 weeks, defined as a total Mayo score of 2 or less and no subscore greater than 1 point. This end point was met by 45% of patients who received vedolizumab every 4 weeks, by 42% who received the drug every 8 weeks, and by 16% of the placebo patients. Clinical remission without corticosteroid treatment occurred in 45% of patients who got vedolizumab every 4 weeks, 31% who got the drug every 8 weeks, and 14% who took placebo. Among patients with a history of anti-TNF treatment, clinical remission after 1 year occurred in 35% of patients maintained with the drug every 4 weeks, 37% who got the drug every 8 weeks, and 5% who took placebo. A total of 209 patients remained in the study through the 52-week assessment.

On May 11, Millennium Pharmaceuticals, the company developing vedolizumab, announced that the drug significantly surpassed placebo for the treatment of Crohn’s disease in the pivotal, phase III trial for that indication. The company said that it will soon report the full Crohn’s disease results.

The GEMINI I study was funded by Millennium. Dr. Feagan said he has been a consultant to Millennium and to several other drug companies. Dr. Sandborn said he has been a consultant to several drug companies but has no relationship with Millennium.

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