• Gauthier Pellet, Carmen Stefanescu, Franck Carbonnel, Laurent Peyrin-Biroulet, Xavier Roblin, Christophe Allimant, Maria Nachury, Stephane Nancey, Jerome Filippi, Romain Altwegg, Hedia Brixi, Ginette Fotsing, Laure de Rosamel, Sarah Shili, David Laharie, and Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif.
• Service d'Hépato-gastro-entérologie, centre hospitalo-universitaire de Bordeaux, Hôpital Haut-Lévêque, Universite Bordeaux, Bordeaux, Pessac, France.
• Clin. Gastroenterol. Hepatol. 2019 Feb 1; 17 (3): 494-501.

Background & AimsVedolizumab is used to treat patients with ulcerative colitis (UC), although there is a delay before it is effective. Induction therapy with a calcineurin inhibitor (cyclosporine or tacrolimus) in combination with vedolizumab as maintenance therapy could be an option for patients with an active steroid-refractory UC. We assessed the efficacy and safety of this combination.MethodsWe performed a retrospective observational study, collecting data from 12 referral centers in France that were included in the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif. We collected information on 39 patients with an active steroid-refractory UC (31 with active severe UC and 36 failed by treatment with a tumor necrosis factor antagonist) who received a calcineurin inhibitor as induction therapy along with vedolizumab as maintenance therapy. Inclusion date was the first vedolizumab infusion. The outcomes were survival without colectomy, survival without vedolizumab discontinuation, and safety.ResultsAfter a median follow-up period of 11 months, 11 patients (28%) underwent colectomy. At 12 months, 68% of the patients survived without colectomy (95% CI, 53%-84%) and 44% survived without vedolizumab discontinuation (95% CI, 27%-61%). No deaths occurred and 4 severe adverse events were observed.ConclusionsIn a retrospective analysis of 39 patients with an active steroid-refractory UC (most refractory to a tumor necrosis factor antagonist), we found that initial treatment with a calcineurin inhibitor in combination with vedolizumab allowed more than two thirds of patients to avoid colectomy. Further studies are needed to assess the safety of this strategy.Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

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