Effects of vedolizumab in patients with primary sclerosing cholangitis and inflammatory bowel diseases

Research output: Contribution to journalArticle

Authors

  • International Primary Sclerosing Cholangitis Study Group (IPSCSG)

Colleges, School and Institutes

External organisations

  • University Laboratory of Physiology, Oxford University, Oxford, UK. ned.jenkinson@physiol.ox.ac.uk
  • Alberta Glycomics Centre, University of Alberta, Alberta, Canada
  • Friedrich-Alexander-University Erlangen-Nürnberg, Germany.
  • Amsterdam University Medical Centres
  • University Medical Center Hamburg-Eppendorf
  • University of California, Davis
  • Department of Radiology University of Miami Miami Florida
  • Autoimmune and Cholestatic Liver Center
  • Karolinska University Hospital and Karolinska Institutet, Stockholm
  • Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre
  • Department of Neurosurgery, Georgetown University Medical Center, Washington, DC, USA.
  • Yale University School of Medicine
  • Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  • Medical University of Vienna
  • University of Gothenburg
  • Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Ospedali Riuniti University Hospital, Ancona, Italy.
  • Division of Hepatology and Liver Transplantation, California Pacific Medical Center, San Francisco, California.
  • Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy.
  • Epatocentro Ticino

Abstract

BACKGROUND & AIMS: Gut-homing lymphocytes that express the integrin α4β7 and CCR9 might contribute to development of primary sclerosing cholangitis (PSC). Vedolizumab, which blocks the integrin α4β7, is used to treat patients with inflammatory bowel diseases (IBD), but there are few data on its efficacy in patients with PSC. We investigated the effects of vedolizumab in a large international cohort of patients with PSC and IBD.

METHODS: We collected data from European and North American centers participating in the International PSC Study Group from patients with PSC and IBD who received at least 3 doses of vedolizumab (n = 102; median vedolizumab treatment duration, 412 days). Demographic and clinical data were collected from baseline and during the follow-up period (until liver transplantation, death, or 56 days after the final vedolizumab infusion). We analyzed overall changes in biochemical features of liver and proportions of patients with reductions in serum levels of alkaline phosphatase (ALP) of 20% or more, from baseline through last follow-up evaluation. Other endpoints included response of IBD to treatment (improved, unchanged, or worsened, judged by the treating clinician, as well as endoscopic score) and liver-related outcomes.

RESULTS: In the entire cohort, the median serum level of ALP increased from 1.54-fold the upper limit of normal at baseline to 1.64-fold the upper limit of normal at the last follow-up examination (P = .018); serum levels of transaminases and bilirubin also increased by a small amount between baseline and the last follow-up examination. Serum levels of ALP decreased by 20% or more in 21 patients (20.6%); only the presence of cirrhosis (odds ratio, 4.48; P = .019) was independently associated with this outcome. Of patients with available endoscopic data, 56.8% had a response of IBD to treatment. Liver-related events occurred in 21 patients (20.6%), including bacterial cholangitis, cirrhosis decompensation, or transplantation.

CONCLUSIONS: In an analysis of patients with PSC and IBD in an international study group, we found no evidence for a biochemical response to vedolizumab, although serum level of ALP decreased by 20% or more in a subset of patients. Vedolizumab appears to be well tolerated and the overall response of IBD was the same as expected for patients without PSC.

Bibliographic note

Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

Details

Original languageEnglish
Pages (from-to)179-187.e6
Number of pages15
JournalClinical Gastroenterology and Hepatology
Volume18
Issue number1
Early online date14 May 2019
Publication statusPublished - Jan 2020

Keywords

  • Cholestatic Liver Disease, Ulcerative Colitis, Crohn’s Disease, Integrin alpha4beta7