P592 Efficacy of vedolizumab for induction and maintenance of clinical remission in ulcerative colitis: The UCLH experience
Bibliographic record
Abstract
Vedolizumab is an α4β7 integrin antagonist which blocks gut-specific leucocyte migration. It is indicated for induction and maintenance of remission in moderate to severe ulcerative colitis (UC) and Crohn’s disease.1 The aim of this study was to characterise the use and efficacy of vedolizumab in the induction and maintenance of remission in UC patients at University College London Hospital, a tertiary UK IBD centre. A retrospective review of all UC patients initiated on vedolizumab from October 2015 to November 2016 was completed. A 52-week follow-up was completed on all patients. Patient characteristics and clinical review data with SCCAI score were collected. Clinical response was defined as a reduction of SCCAI to <3 from baseline at Week 14, 30 and Week 52. Clinical remission was defined as SCCAI ≤2 or endoscopic evidence of quiescent disease. Forty-five UC patient records were examined; six patients were excluded due to incomplete data for Weeks 0–14 outcomes. Clinical review at 1 year of excluded patients showed five patients in clinical remission. Complete data were reviewed for 39 patients, 26 male, 13 female. Montreal classification identified 19 patients with pancolitis (E3), 14 with left sided disease (E2) and 6 with proctitis (E1). Average age at diagnosis was 26 and age at starting vedolizumab was 32 with average duration of disease 6.23 years. 43% had failed at least one previous tumour necrosis factor antagonist (anti-TNF). Concomitant immunomodulators were used in 69% of patients, 19 with a thiopurine analogue, and 8 using methotrexate. Average number of vedolizumab infusions to clinical response was 2.41. Average faecal calprotectin reduced from 2163 to 828. No difference was identified in number of infusions required to induce clinical remission between anti-TNF naive and exposed patients (2.5 vs. 2.18). 10 patients were primary non-responders at 14 weeks. Three patients required colectomy with one planned. Anti-TNF therapy was used in six patients of which only one patient has responded well. No difference was identified in average SCCAI scores at Week 0 between responders and primary non-responders. Clinical response at Week 14 predicted remission in all but five patients at Week 52 review. This real-world study demonstrates that vedolizumab is equally efficacious in anti-TNF therapy naive and exposed UC patients. Clinical response at 14 weeks predicts the likelihood of maintaining clinical remission at 52 weeks. Use of anti-TNF medication to induce remission in UC patients after failure of vedolizumab may not be of benefit. 1. Feagan B et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. New Eng J Med, 2013;369: 699–710, doi:10.1056/NEJMoa1215734.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".