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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Gastroenterology

Advisor

Dr. Elyse Watkins, DHSc, PA-C, DFAAPA

Abstract

An Evaluation of Vedolizumab to Achieve and Maintain Remission of Crohn’s Disease in Patients with and without Prior Exposure to Tumor Necrosis Factor Antagonists

ABSTRACT:

Purpose: The purpose of this article is to review treatment with vedolizumab in patients who have Crohn’s disease, with and without prior exposure to tumor necrosis factor (TNF) antagonists.

Method: A PubMed literature search for high quality studies evaluating vedolizumab treatment in patients with moderate to severe Crohn’s disease was performed. The terms Crohn’s disease, vedolizumab, and TNF were entered into Pub Med and the limits of clinical trial, clinical study, meta-analysis, randomized controlled trial, review, and systematic review were applied. Articles pertaining to pediatric patients, pharmacology, genetics, comparison of individual integrin blockers, surgical outcomes, ulcerative colitis, health insurance, and cost effectiveness were eliminated because they did not directly relate to the topic. The GEMINI 2, GEMINI 3, and GEMINI LTS studies were evaluated, and they serve as the basis for this clinical review. Several smaller studies were also included in this literature review.

Results: There are several studies to support the use of vedolizumab in patients with moderate to severe Crohn’s disease with and without prior exposure to TNF antagonists. Studies that seek to establish a specific patient population who would benefit from vedolizumab treatment are being performed.

Conclusion: Crohn’s disease is a chronic, generally progressive, inflammatory disease that can affect the digestive system from mouth to anus. During the course of the disease, patients may require treatment with vedolizumab. This paper presents three level 1 randomized studies that evaluate the efficacy and safety of vedolizumab to achieve and maintain remission in patients with moderate to severe Crohn’s disease. One of the studies is inclusive of patients with Crohn’s disease despite previous medications, the second study focuses on patients who have previously been treated with TNF antagonists, the third study evaluates the long-term safety and efficacy of vedolizumab. Several smaller studies have also concluded that vedolizumab is a safe and effective treatment for patients with Crohn’s disease despite prior treatment with TNF antagonists. Based on these studies, vedolizumab treatment should be considered in patients with moderate to severe Crohn’s disease whether or not there was prior TNF antagonist exposure.

Keywords: Crohn’s disease, TNF, vedolizumab

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