Vedolizumab serum trough concentrations and response to dose escalation in inflammatory bowel disease

Byron P. Vaughn, Andres J. Yarur, Elliot Graziano, James P Campbell, Abhik Bhattacharya, Jennifer Y. Lee, Katherine Gheysens, Konstantinos Papamichael, Mark T. Osterman, Adam S. Cheifetz, Raymond K. Cross

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Serum vedolizumab concentrations are associated with clinical response although, it is unknown if vedolizumab concentrations predict response to dose escalation. The aim of this study was to identify if vedolizumab trough concentrations predicted the response to vedolizumab dose escalation. We assessed a retrospective cohort of patients on maintenance vedolizumab dosing at five tertiary care centers with vedolizumab trough concentrations. Multivariate logistic regression was used to control for potential confounders of association of vedolizumab concentration and clinical status. Those who underwent a dose escalation were further examined to assess if vedolizumab trough concentration predicted the subsequent response. One hundred ninety-two patients were included. On multivariate analysis, vedolizumab trough concentration (p = 0.03) and the use of immunomodulator (p = 0.006) were associated with clinical remission. Receiver operator curve analysis identified a cut off of 7.4 μg/mL for clinical remission. Of the fifty-eight patients with dose escalated, 74% of those with a vedolizumab concentration <7.4 μg/mL responded versus 52% of those with a vedolizumab trough concentration ≥7.4 μg/mL (p = 0.08). After adjustment for relevant confounders, the odds ratio for response with vedolizumab concentration <7.4 μg/mL was 3.7 (95% CI, 1.1–13; p = 0.04). Vedolizumab trough concentration are associated with clinical status and can identify individuals likely to respond to dose escalation. However, a substantial portion of patients above the identified cut off still had a positive response. Vedolizumab trough concentration is a potentially helpful factor in determining the need for dose escalation in patients losing response.

Original languageEnglish (US)
Article number3142
Pages (from-to)1-11
Number of pages11
JournalJournal of Clinical Medicine
Volume9
Issue number10
DOIs
StatePublished - Oct 2020

Bibliographical note

Funding Information:
The support of the Namibian authorities and of the University of Namibia in facilitating the construction and operation of H.E.S.S. is gratefully acknowledged, as is the support by the German Ministry for Education and Research (BMBF), the Max Planck Society, the French Ministry for Research, the CNRS-IN2P3 and the Astroparticle Interdisciplinary Programme of the CNRS, the U.K. Science and Technology Facilities Council (STFC), the IPNP of Charles University, the Polish Ministry of Science and Higher Education, the South African Department of Science and Technology and National Research Foundation, and the University of Namibia. We appreciate the excellent work of the technical support staff in Berlin, Durham, Hamburg, Heidelberg, Palaiseau, Paris, Saclay, and Namibia in the construction and operation of the equipment.

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • Crohn’s disease
  • Therapeutic drug monitoring
  • Ulcerative colitis

PubMed: MeSH publication types

  • Journal Article

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