Vedolizumab Dose Escalation: In for a Penny, in for a Pound?
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EDITORIAL
Vedolizumab Dose Escalation: In for a Penny, in for a Pound? Robin J. Dart1,2 · Peter M. Irving2,3 · Mark A. Samaan3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Regarding the choices of biologic agents for IBD, as is for all therapeutic interventions, it is often said that the most expensive drug is the one that fails to work. This is probably no truer than in the case of dose-escalated vedolizumab. There exists, therefore, a genuine desire within the IBD community to better understand exactly how effective dose escalation is and in which circumstances it is most likely to succeed. The desire to derive maximal benefit from vedolizumab is borne out of the fact that the number of approved therapies in IBD remains limited and that rates of non-response (primary and secondary) remain significant. For ulcerative colitis (UC) specifically, there are now six approved novel agents encompassing four different mechanisms of action (anti-TNF, antiIL12/23, anti-integrin, and Janus kinase (JAK) inhibition), a choice far more limited than those available for the treatment of rheumatoid arthritis, for example, which has at least twice as many advanced therapies available. Moreover, failure of medical therapy in UC generally necessitates life-altering surgery, in the form of colectomy and ileostomy formation. It, therefore, stands to reason that IBD clinicians should do everything in their power to extract the most from the currently available range of agents. Marching in lockstep with this aspiration is the necessity for IBD researchers to generate data informing their optimal use. In this issue of Digestive Diseases and Sciences, Perry and colleagues [1] reported a retrospective study designed to investigate the observational effectiveness of vedolizumab dose escalation in a group of patients with UC. Amongst their cohort of 22 patients treated with vedolizumab with a partial response to standard 8-weekly dosing, 10 (45.5%) * Mark A. Samaan [email protected] 1
Department of Gastroenterology, Royal Free Hospital, London, UK
2
School of Immunology and Microbial Sciences, King’s College London, London, UK
3
Department of Gastroenterology, St Thomas’ Hospital, Guy’s & St Thomas’, First Floor College House, North Wing, Westminster Bridge Road, London SE1 7EH, UK
were observed to achieve remission (partial Mayo score (pMayo) of 0 or 1) upon dose escalation to 4-weekly, with the overall average pMayo score of the group falling from 4.4 at the point of escalation to 1.7 by the end of follow-up (p
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