DOP049 Vedolizumab is more effective at inducing histo-endoscopic healing in early Crohn’s Disease compared to late CD, with comparable healing rates regardless of disease location: data from the LOVE-CD trial
Bibliographic record
Abstract
Abstract Background Achieving deep remission, encompassing clinical, endoscopic, and biological remission, is a long-term goal in Crohn's disease [CD] according to the STRIDE-2 guidelines. The role of histological remission in CD remains unclear. We evaluated the efficacy of vedolizumab [VDZ] for inducing histo-endoscopic remission in early versus late CD in the prospective, open-label LOVE-CD trial conducted in Belgium, the Netherlands and Hungary. Methods In the LOVE-CD trial, patients with moderate-to-severe disease (Crohn’s Disease Activity Index 220-450 and presence of ulcers at baseline endoscopy) received intravenous vedolizumab over a 52-week period. Early CD was defined as a diagnosis <24 months (treatment-naive or history of corticosteroid and/or immunomodulator use), and late CD as a diagnosis >24 months with prior anti-TNF exposure. Ileocolonoscopies were performed at three timepoints (baseline, week 26, week 52) during which biopsies were systematically collected in the terminal ileum and colon. Both the endoscopies and biopsies were centrally scored by experienced readers for the simple endoscopic score for Crohn's disease [SES-CD], Robarts’ histopathology index [RHI], and Geboes score [GS]. Endoscopic remission, histo-endoscopic mucosal improvement [HEMI], and histo-endoscopic mucosal remission [HEMR] were defined as SES-CD <4, GS ≤3B.1, and GS <2B.1 respectively. The association between histologic and endoscopic scores was studied with Spearman’s correlation coefficient. Intention-to-treat analysis with non-responder imputation was used to handle missing data. Results Of the 260 patients included in LOVE-CD (Table), 440 biopsies (336 colon, 114 ileum) from 179 patients at week 26, and 435 biopsies (323 colon, 112 ileum) from 177 patients at week 52 were analysed. There was a strong correlation between the endoscopic and histological assessment (colon r 0.69, ileum r 0.64, total r 0.64, p<0.001). Patients with early CD were more likely to achieve histological remission than patients with late CD at week 52 (38.4 % vs. 14.9%, p=0.00004). Endoscopic and histological healing rates at week 26 (endoscopic remission 36.9%, HEMI 30.4%, HEMR 24.2%) and week 52 (endoscopic remission 35%, HEMI 30%, HEMR 22.7%) were comparable. When looking at disease location, histological remission rates in the colon and ileum did not significantly differ (35.2% vs. 27.8%, p=0.15). Conclusion Vedolizumab was more efficient at inducing histo-endoscopic remission in early CD as compared to late CD, with most of the histo-endoscopic healing occurring during the first 26 weeks. Histo-endoscopic healing rates under vedolizumab were comparable in colonic and ileal disease. Histological scores (RHI, GS) are also applicable for the evaluation of ileal and colonic CD.
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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 | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".