Dr El Ouali discusses research she and colleagues presented at DDW 2023 on the efficacy of non-antitumor necrosis factor biologics, including vedolizumab, in treatment of patients with stricturing Crohn's disease over a 2-year period.

Sara El Ouali, MD, is a gastroenterologist at Cleveland Clinic Abu Dhabi, United Arab Emirates.

TRANSCRIPT:

Hello, I am Sara El Quali. I am a gastroenterologist at the Cleveland Clinic in Abu Dhabi, and today I'll be talking to you a little bit about the research we presented here at DDW 2023. What we really wanted to look at was the impact of non-anti -NF biologics, including vedolizumab and ustekinumab, in the management of patients with ileal stricturing Crohn's disease. Now, patients with ileal stricturing Crohn's disease, we have quite a few in our clinics, and it is a true clinical challenge as you know, a lot of these patients are not included in clinical trials.

The whole idea is that strictures are fibrotic and may not respond to biologic therapy. And so what we really wanted to see is whether these patients do respond to biologics. We do have some data on infliximab and adalimumab, but we actually do not really have much data on vedolizumab and ustekinumab.

So what we did is we ran a multicenter international observational cohort study. We had included study patients essentially from the US, from Canada, from the Middle East, and we really tried to look at patients with purely stricturing disease, and so no underlying fistulas or anything. And we tried to have a standardized definition of strictures. We used the recent constrict criteria to really define those strictures. Patients had to have ileal stricturing disease on cross-sectional imaging—that could have been a CT angiography, an MRI angiography, or an intestinal ultrasound. They had to have that cross-sectional imaging within 6 months of starting the biologic. We looked at outcomes such as the need for endoscopic balloon dilation, the need for surgery or intervention, which was a combined endpoint, as well as obstructive symptoms during follow-up and drug persistence, which is an important outcome there.

And so for the vedolizumab cohort, we had about 44 patients, and what we found is about 20% needed surgery at 2 years, 30% needed endoscopic balloon dilation at 2 years, and then drug persistence was actually still in 75% of patients or so at 2 years, and really indicating that it might be working in those patients. We also had about 50% of patients that improved, their obstructive symptoms improved, even resolved on follow-up, but with a recurrence of about 25 to 50%, really showing us that vedolizumab may be a really good option for stricturing Crohn's disease, even in patients that are actually highly refractory to prior biologics. It's important to note that of the vedolizumab cohort, about 85% of patients had been on prior biologics.

In terms of ustekinumab, similar results overall—95% of our patients had been on a prior biologic, so quite highly refractory Crohn's disease there. And 57% patients were included total. Again, what we found is that there was about 75% drug persistence at 2 years, really showing us that this could be an option for those patients. And so essentially the take-home message is that both vedolizumab or ustekinumab could really be used in the treatment of ileal structuring Crohn's disease. But of course, we need more, we need prospective data and more data to really guide us on the treatment of ileal stricturing Crohn's disease.