JPGN Reports · 3 authors, 2 centres
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This retrospective cohort study evaluated vedolizumab in 39 pediatric patients with anti-TNF refractory IBD, finding that corticosteroid- and biologic-free remission rates declined over 2 years (e.g., 29% CD and 16% UC at 1 year; 21% CD and 40% UC at 2 years). The main limitation is its small, single-center, retrospective design, which limits generalizability.
Pediatric inflammatory bowel disease (PIBD) is often aggressive, and anti-TNF therapies can fail, necessitating alternative treatments like vedolizumab. This study aimed to assess the long-term effectiveness of vedolizumab in anti-TNF refractory PIBD. Methods: A real-life, single-center, retrospective study was conducted on 39 PIBD patients (19 CD, 20 UC) treated with vedolizumab at Texas Children's Hospital. Data were collected at 14 weeks, 26 weeks, 1 year, and 2 years. The primary outcome was corticosteroid- and other biologic-free remission (PUCAI <10). Results: At 1 year, 65% of CD and 68% of UC patients continued vedolizumab, with corticosteroid- and biologic-free remission in 29% of CD and 16% of UC. By 2 years, 36% of CD and 47% of UC remained on therapy, with remission in 21% of CD and 40% of UC. Notably, 80% of CD and 100% of UC patients on therapy at 2 years required intensified regimens. Nine patients (23%) needed surgery within 26 months. No serious adverse events were reported. Limitations: The study is retrospective, single-center, and uses PUCAI for all patients (including CD) due to data limitations. Sample size is small, and therapeutic drug monitoring was inconsistent. Implications: Vedolizumab appears safe but shows declining effectiveness over 2 years in anti-TNF refractory PIBD. Intensified regimens may support long-term maintenance, but larger prospective trials are needed to optimize treatment.
