Real-world Effectiveness and Safety of Vedolizumab for the Treatment of Inflammatory Bowel Disease: The Scottish Vedolizumab Cohort.

BACKGROUND & AIMS: Vedolizumab is an anti-a4b7 monoclonal antibody that is licensed for the treatment of moderate to severe Crohn's disease and ulcerative colitis. The aims of this study were to establish the real-world effectiveness and safety of vedolizumab for the treatment of inflammatory bowel disease. METHODS: This was a retrospective study involving seven NHS health boards in Scotland between June 2015 and November 2017. Inclusion criteria included: a diagnosis of ulcerative colitis or Crohn's disease with objective evidence of active inflammation at baseline (Harvey-Bradshaw Index[HBI] ≥5/Partial Mayo ≥2 plus C-reactive protein [CRP] >5 mg/L or faecal calprotectin ≥250 µg/g or inflammation on endoscopy/magnetic resonance imaging [MRI]); completion of induction; and at least one clinical follow-up by 12 months. Kaplan-Meier survival analysis was used to establish 12-month cumulative rates of clinical remission, mucosal healing, and deep remission [clinical remission plus mucosal healing]. Rates of serious adverse events were described quantitatively. RESULTS: Our cohort consisted of 180 patients with ulcerative colitis and 260 with Crohn's disease. Combined median follow-up was 52 weeks (interquartile range [IQR] 26-52 weeks). In ulcerative colitis, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 57.4%, 47.3%, and 38.5%, respectively. In Crohn's disease, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 58.4%, 38.9%, and 28.3% respectively. The serious adverse event rate was 15.6 per 100 patient-years of follow-up. CONCLUSIONS: Vedolizumab is a safe and effective treatment for achieving both clinical remission and mucosal healing in ulcerative colitis and Crohn's disease.

Assessing the residential care needs of nursing home applicants.

In a study of nursing home applicants, residential care decisions made by a multidisciplinary assessment team were examined. The team agreed that of the 296 applicants assessed, 54 per cent required the high level of physical and supportive care provided in a nursing home. Hostel care was recommended for 17 per cent, continuing care at home for 17 per cent, hospice care for 1 subject, and in 13 per cent of cases the team postponed their decision. A decision for nursing home care was associated with low Barthel Index of Activities of Daily Living scores, dementia, incontinence and the absence of a carer willing to continue care. A decision to delay was associated, in most cases, with a requirement for further in-patient assessment and/or rehabilitation, and therefore with a potential for functional improvement. A decision for hostel care instead of home care was associated with a low level of informal support and the absence of a carer who was a spouse or daughter. The findings suggest that a program of geriatric assessment will accurately identify the differing care needs of nursing home applicants. The initial value of such an assessment program may be to contribute to the planning of residential and other long-term care services rather than to reduce inappropriate nursing home admissions.