Vedolizumab Superior to Infliximab for Management of Immune-Mediated Diarrhea and Colitis

Investigators of the retrospective cohort study compared the efficacy of selective immunosuppressive therapy on immune-mediated diarrhea and colitis.

Vedolizumab was found to afford better management of immune-mediated diarrhea and colitis (IMDC) than infliximab in a retrospective cohort study, the results of which were presented at the 2020 American College of Gastroenterology (ACG) Annual Scientific Meeting. Specifically, vedolizumab therapy correlated with “significant” improvement in IMDC disease course, reduced steroid exposure, lower IMDC recurrence, increased long-term overall survival, and equal efficacy of clinical remission when compared with infliximab.

Patients who received vedolizumab had shorter steroid treatment (35 vs 50 days; P <.001), fewer steroid tapering attempts (1 vs 2; P <.001), and a shorter duration of hospital stay (11 vs 14 days; P =.025). Overall survival was positively associated with vedolizumab monotherapy (P =.042), higher selective immunosuppressant therapy dosage (P =.026), and fewer steroid tapering attempts (P =.019).

IMDC symptom recurrence was associated with longer durations of ICI therapy (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P =.018), colitis symptoms (OR, 1.12; 95% CI, 1.01-1.22; P =.025), and steroid use (OR, 1.56; 95% CI, 1.05-2.03; P =.035). Use of infliximab and delayed initiation of selective immunosuppressive therapy (SIT) following first-line steroids correlated with more frequent IMDC recurrence. By contrast, multiple doses of SIT (≥3 doses) were “significantly associated with lower IMDC recurrence,” the study authors wrote (P =.032).

IMDC recurrence was also “significantly lower” in the vedolizumab group, the investigators said (13% vs 28%; P =.018). However, a slight delay of clinical response was observed with vedolizumab (17 vs 10 days; P =.003). Patients receiving either monotherapy achieved remission for IMDC symptoms at a similar rate (vedolizumab, 89% vs infliximab, 87%; P =.865).

The study population included 150 patients with IMDC who received SIT (vedolizumab or infliximab) after first-line steroids between June 2016 and March 2020. Patients were treated with infliximab (n=71), vedolizumab (n=61), or both (n=18) and were assessed for clinical characteristics and disease progression.

The median patient age was 64 years. 69% of patients were men, 97% were White, and most had genitourinary cancer or melanoma (total, >70%). Vedolizumab was often administered in 3 or more doses; infliximab was limited to 1 or 2 doses (P <.001).

These data indicate that vedolizumab monotherapy may be superior to infliximab for IMDC symptom improvement after treatment with ICIs. However, a “future prospective randomized trial is still merited for further clarification,” the study authors concluded.

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Zou F, Shah AY, Glitza IC, et al. Comparative study of vedolizumab and infliximab treatment in patients with immune-mediated diarrhea and colitis. Presented at: American College of Gastroenterology Annual Scientific Meeting; October 26-28, 2020. Abstract S0137.