Scarozza Patrizio, Marafini Irene, Laudisi Federica, Troncone Edoardo, Schmitt Heike, Lenti Marco Vincenzo, Costa Stefania, Rocchetti Irene, De Cristofaro Elena, Salvatori Silvia, Frezzati Ludovica, Di Sabatino Antonio, Atreya Raja, Neurath Markus F, Calabrese Emma, Monteleone Giovanni
Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.
Department of Medicine 1, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
J Clin Med. 2020 Feb 1;9(2):385. doi: 10.3390/jcm9020385.
Randomized controlled clinical trials and real-life observations indicate that less than 50% of patients with Crohn's disease (CD) or ulcerative colitis (UC) respond to vedolizumab, a humanized monoclonal antibody that blocks the α4β7 integrin. Since α4β7-expressing lymphocytes mainly infiltrate the left colon, we assessed whether localization of CD and UC influences vedolizumab-induced remission. One hundred and eighty-one patients (74 CD and 107 UC) receiving vedolizumab in 3 referral centers were retrospectively evaluated for clinical remission at week 14. Demographic and clinical characteristics were compared between remitters and non-responders, and multivariable multinomial analysis was performed to identify predictors of remission. Remission was achieved in 17 CD (23%) and 34 UC (32%) patients, respectively. In CD, localization of the lesions did not influence clinical remission. In UC, the remitters had more frequently a distal/left-sided colitis (21/34, 62%) as compared to the non-responders (9/47, 19%), and extensive colitis was more frequent in the non-responders (38/47, 81%) than in the remitters (13/34, 38%). The multivariable multinomial analysis showed that distal/left-sided colitis was associated with a higher probability of clinical remission while extensive colitis was inversely associated with induction of remission. Data indicate that UC patients with distal or left-sided colitis are more likely to achieve remission than patients with extensive colitis following vedolizumab treatment.
随机对照临床试验和实际观察表明，不到50%的克罗恩病（CD）或溃疡性结肠炎（UC）患者对维多珠单抗有反应，维多珠单抗是一种阻断α4β7整合素的人源化单克隆抗体。由于表达α4β7的淋巴细胞主要浸润左半结肠，我们评估了CD和UC的病变部位是否会影响维多珠单抗诱导的缓解。对3个转诊中心接受维多珠单抗治疗的181例患者（74例CD和107例UC）进行回顾性评估，以确定第14周时的临床缓解情况。比较缓解者和无反应者的人口统计学和临床特征，并进行多变量多项分析以确定缓解的预测因素。分别有17例CD患者（23%）和34例UC患者（32%）实现缓解。在CD中，病变部位不影响临床缓解。在UC中，与无反应者（9/47，19%）相比，缓解者更常患有远端/左侧结肠炎（21/34，62%），无反应者中广泛性结肠炎（38/47，81%）比缓解者（13/34，38%）更常见。多变量多项分析表明，远端/左侧结肠炎与临床缓解的较高概率相关，而广泛性结肠炎与缓解诱导呈负相关。数据表明，维多珠单抗治疗后，患有远端或左侧结肠炎的UC患者比患有广泛性结肠炎的患者更有可能实现缓解。
