Maintenance of remission among patients with inflammatory bowel disease after vedolizumab discontinuation: a multicentre cohort study

INTRODUCTION: It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease (IBD) after achieving steroid-free clinical remission. AIM: To assess the risk of relapse after vedolizumab therapy was discontinued. PATIENTS AND METHODS: Retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD who were in steroid-free clinical remission for at least three months and were treated with vedolizumab for at least six months were included at the time of vedolizumab discontinuation. RESULTS: Ninety-five patients (58 with Crohn's disease) discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 (5.8-17.7) months, 61 (64%) patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59% and 36% at 6, 12 and 18 months, respectively. According to the multivariate analysis, a CRP level less than 5 mg/L at vedolizumab discontinuation (HR=0.56, 95% CI [0.33-0.95], p=0.03) and discontinuation due to patients' elective choice (HR=0.41, 95% CI [0.21-0.80], p=0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. CONCLUSION: In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.