Vedolizumab after resection helps prevent CD recurrence

For patients with Crohn’s disease (CD) who are scheduled to undergo ileocolonic resection, initiating vedolizumab treatment promptly after the procedure has the potential to prevent recurrence, according to the results of the REPREVIO study.

REPREVIO included 80 adult CD patients who underwent ileocolonic resection and had at least one risk factor for recurrence. These patients were randomly assigned to receive treatment with vedolizumab 300 mg (n=43) or placebo (n=37) within 4 weeks of the surgical procedure. Treatment was administered intravenously at weeks 0, 8, 16, and 24.

At week 26, all patients underwent ileocolonoscopy for the identification of endoscopic recurrence. Recurrence was evaluated using the modified Rutgeerts score. The primary endpoint was the distribution of modified Rutgeerts scores between treatment groups at week 26, while the key secondary endpoint was the proportion of patients with severe endoscopic recurrence at week 26 (modified Rutgeerts score ≥i2b).

Results for the primary and key secondary endpoints were significant. The probability of a lower modified Rutgeerts score with vedolizumab than with placebo at week 26 was 77.8 percent (95 percent confidence interval [CI], 66.4–86.3; p<0.0001). Significantly fewer patients in the vedolizumab group than in the placebo group had severe endoscopic recurrence (23.3 percent vs 62.2 percent; difference, –38.9 percent, 95 percent CI, –56.0 to –17.3; p=0.0004).

In terms of safety, three vedolizumab-treated patients (7.0 percent) had serious adverse events, including bilateral tubo-ovarian abscesses, thrombosed haemorrhoids, and pancreatic adenocarcinoma. In the placebo group, two patients (5.4 percent) had intestinal perforation related to CD and severe abdominal pain.

Researchers called for larger studies with longer follow-up to establish the role of vedolizumab in this population.