Favorable Outcomes Combining Vedolizumab with Other Biologics or Tofacitinib for Treatment of Inflammatory Bowel Disease

Ernesto M. Llano, Shreeju Shrestha, Ezra Burstein, Moheb Boktor, David I. Fudman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Combining advanced therapies may improve outcomes in inflammatory bowel disease (IBD), but there are little data on the effectiveness and safety of this approach. Methods: We examined outcomes of patients who received vedolizumab in combination with another biologic or tofacitinib between 2016 and 2020. Results: Fourteen patients (10 ulcerative colitis [UC], 3 Crohn disease, 1 indeterminate colitis) received a combination of advanced therapies. Vedolizumab was combined with tofacitinib in 9 patients, ustekinumab in 3, and adalimumab in 2. Median follow-up on combination therapy was 31 weeks. Normalization of C-reactive protein (CRP) or fecal calprotectin (<5 mg/L and <150 μg/g, respectively) was achieved in 56% (5/9) and 50% (4/8) of patients. Paired median CRP decreased from 14 mg/L to <5 mg/L with combination therapy (n = 9, P = 0.02), and paired median calprotectin from 594 μg/g to 113 μg/g (n = 8, P = 0.12). Among patients with UC, paired median Lichtiger score decreased from 9 to 3 (n = 7, P = 0.02). Prednisone discontinuation was achieved in 67% (4/6) of prednisone-dependent patients. There were 4 infections: 2 required hospitalization (rotavirus, Clostridium difficile), and 2 did not (pneumonia, sinusitis). During follow-up, 5/14 patients discontinued combination therapy (2 nonresponse; 1 improvement and de-escalation; 1 noninfectious adverse effect; 1 loss of coverage). Conclusions: In this retrospective case series of a cohort with refractory IBD, combining vedolizumab with other biologics or tofacitinib improved inflammatory markers, reduced clinical disease activity and steroid use, and was well tolerated.

Original languageEnglish (US)
Article numberotab030
JournalCrohn's and Colitis 360
Volume3
Issue number3
DOIs
StatePublished - Jul 1 2021

Keywords

  • combination
  • tofacitinib
  • vedolizumab

ASJC Scopus subject areas

  • Gastroenterology

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