Evaluation of Efficacy and Safety of Vedolizumab in Treatment of Active Inflammatory Bowel Disease / 胃肠病学

ABSTRACT

Background: Inflammatory bowel disease (IBD) is a non-specific inflammatory disease of the gastrointestinal tract with a course of repeated episodes and remissions. Vedolizumab (VDZ), a selective blocker of interaction between leukocytes and vascular endothelium of the gut, has been demonstrated effective in treatment of active IBD. Aims: To systematically evaluate the efficacy and safety of VDZ for active IBD. Methods: PubMed, Embase, Cochrane Library and Google Scholar were retrieved to collect randomized controlled trials (RCTs) comparing VDZ and placebo in patients with IBD published in English before Aug. 2018. Meta-analysis was conducted by using RevMan 5.30 software. Results: Eight RCTs involving 3 159 active IBD patients were included. Meta-analysis showed that VDZ was superior to placebo in inducing clinical response, clinical remission and endoscopic remission in active UC (RR=1.62, 95% CI 1.33-1.97, P<0.000 01; RR=2.45, 95% CI 1.56-3.83, P<0.000 1; RR=1.75, 95% CI 1.29-2.37, P=0.000 3, respectively) and in maintenance of clinical remission in inactive UC (RR=2.43, 95% CI 1.73-3.41, P<0.000 01). Also, VDZ was superior to placebo in inducing clinical response and clinical remission in active CD (RR=1.47, 95% CI 1.21-1.79, P=0.000 1; RR=1.87, 95% CI 1.37-2.56, P<0.000 1, respectively). Subgroup analysis revealed that clinical remission was only achieved in CD patients naive to anti-tumor necrosis factor-α (TNF-α) therapy. Only one trial described the clinical remission in inactive CD, the results showed that VDZ was superior to placebo. Except for nasopharyngitis, adverse events were similar between VDZ group and placebo group. Conclusions: VDZ is safe and effective for induction and maintenance of remission in active IBD, but may be not more effective than placebo in CD patients failure to anti-TNF-α therapy.