Meserve Joseph, Dulai Parambir
Department of Gastroenterology, University of California, San Diego, San Diego, CA, United States.
Front Med (Lausanne). 2020 Apr 2;7:76. doi: 10.3389/fmed.2020.00076. eCollection 2020.
Vedolizumab is known to be safe, well-tolerated, and effective. However, as personalization becomes an increasingly important aspect of IBD care and in lieu of guidelines to inform clinicians on positioning of biologics, there is a need to reliably predict response to inform patient preferences and shared decision-making. Recent data from clinical trials and real-world evidence have elucidated predictors of clinical and endoscopic response while providing the framework to establish predictive models. Current models are able to predict that those patients with less severe disease, without prior biologic exposure and who demonstrate early response to VDZ have the highest rates of durable clinical and endoscopic response and remission. When incorporating these models into clinical practice, clinicians will be able to identify those patients who are likely to respond before drug initiation as well as early non-responders and response latency after initiation of vedolizumab. In a shift toward personalization of medicine in IBD, the ability of predictive models for vedolizumab to aid pre-biologic and early management will inform both clinician and patient. Ideally this will provide both a personalized and more cost-effective approach, though further studies in cost-analysis in this framework are needed. Though current models are comprehensive of existing data, future research on microbial and translational biomarkers will be additive and necessary to provide full personalization of treatment.
维多珠单抗已知具有安全性、耐受性良好且有效。然而，随着个性化成为炎症性肠病（IBD）治疗中日益重要的方面，且缺乏指导临床医生确定生物制剂使用顺序的指南，因此需要可靠地预测疗效，以告知患者偏好并促进共同决策。来自临床试验和真实世界证据的最新数据阐明了临床和内镜反应的预测因素，同时为建立预测模型提供了框架。目前的模型能够预测，那些疾病不太严重、未接受过生物制剂治疗且对维多珠单抗表现出早期反应的患者，具有持久临床和内镜反应及缓解的最高几率。将这些模型纳入临床实践后，临床医生将能够在开始用药前识别可能有反应的患者，以及早期无反应者和维多珠单抗开始使用后的反应延迟情况。在IBD治疗向个性化转变的过程中，维多珠单抗预测模型辅助生物制剂治疗前及早期管理的能力将为临床医生和患者提供参考。理想情况下，这将提供一种个性化且更具成本效益的方法，不过在此框架下还需要进一步开展成本分析研究。尽管目前的模型综合了现有数据，但未来关于微生物和转化生物标志物的研究将是补充性的且必不可少，以实现治疗的完全个性化。
