Treatment of Vedolizumab With Exclusive Enteral Nutrition in Adult Patients With Moderate to Severe Crohn's Disease (Crohn Exclusive Enteral Nutrition Study).
Jing Wang, Zhishun Tang, Jiao Li, Anning Yin, Yaqing Xu, Liping Zou, Haixia Ren, Jian Kang, Juan Su, Qian Zhou, Yang Wang, Wei Wang, Jing Zhang, Huipeng Wan, Ping An
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引用次数: 0
Abstract
Introduction: Despite increasing studies confirming the efficacy of vedolizumab (VDZ) in Crohn's disease (CD), improving the responses to this biologic agent remains challenging in clinical practice. In this article, we investigated the efficacy of combined treatment of VDZ and 16-week exclusive enteral nutrition (EEN) in moderately to severely active CD.
Methods: From October 2020 to October 2023, 81 patients with moderately to severely active CD treated with VDZ from 2 inflammatory bowel disease centers were retrospectively selected. Forty-one patients received treatment of VDZ with concomitant 16-week EEN (VDZ + EEN cohort), and 40 patients received VDZ treatment alone (VDZ cohort). Clinical and biological outcomes were evaluated. Endoscopic response and mucosal healing were assessed by colonoscopy at weeks 16 and 52.
Results: There was no statistically significant difference between 2 groups at baseline for demographic and clinical characteristics. Compared with patients treated with VDZ alone, patients in the VDZ + EEN cohort achieved higher rates of clinical response (84.2% vs 40.0%), clinical remission (81.6% vs 30.0%), endoscopic response (91.4% vs 34.6%), including mucosal healing (85.7% vs 26.9%) at week 16. The superiority of VDZ + EEN treatment sustained in maintenance, with 76.7% (vs 33.3%) clinical response, 70.0% (vs 26.7%) clinical remission, 76.9% (vs 33.3%) endoscopic response, and 61.5% (vs 26.7%) mucosal healing at week 52. None of the patients experienced severe adverse events.
Discussion: VDZ with concomitant 16-week EEN might be an effective and optimized approach with solid efficacy in the induction and maintenance treatment of active CD.
背景:尽管越来越多的研究证实了维多珠单抗对克罗恩病(CD)的疗效,但在临床实践中,改善对这种生物制剂的反应仍具有挑战性。在此,我们研究了维多珠单抗和16周纯肠内营养(EEN)联合治疗中度至重度活动性克罗恩病的疗效:回顾性选取了2020年10月至2023年10月期间,来自三个IBD中心的81例接受维多珠单抗治疗的中重度活动性CD患者。41名患者接受了韦多珠单抗治疗,并同时接受了为期16周的EEN治疗(韦多珠单抗,VDZ+EEN队列),40名患者单独接受了韦多珠单抗治疗(VDZ队列)。对临床和生物学结果进行了评估。在第16周和第52周通过结肠镜检查评估内镜反应和粘膜愈合情况:结果:两组患者在人口统计学和临床特征方面的基线差异无统计学意义。与单独接受维多珠单抗治疗的患者相比,VDZ+EEN组患者在第16周时的临床应答率(84.2% vs. 40.0%)、临床缓解率(81.6% vs. 30.0%)、内镜应答率(91.4% vs. 34.6%)和粘膜愈合率(85.7% vs. 26.9%)均较高。VDZ+EEN治疗的优越性在维持治疗中得以保持,第52周时,临床应答率为76.7%(vs 33.3%),临床缓解率为70.0%(vs 26.7%),内镜应答率为76.9%(vs 33.3%),粘膜愈合率为61.5%(vs 26.7%)。没有患者出现严重不良反应:韦多珠单抗联合16周EEN可能是诱导和维持治疗活动性CD的一种有效且疗效确切的优化方法。
期刊介绍:
Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease.
Colon and small bowel
Endoscopy and novel diagnostics
Esophagus
Functional GI disorders
Immunology of the GI tract
Microbiology of the GI tract
Inflammatory bowel disease
Pancreas and biliary tract
Liver
Pathology
Pediatrics
Preventative medicine
Nutrition/obesity
Stomach.