796 Effect of Disease Location on Endoscopic and Radiographic Outcomes in Patients With Moderate to Severe Crohn's Disease Initiated on Vedolizumab

Abstract

INTRODUCTION: Vedolizumab (VDZ), an integrin antagonist, is approved to treat moderate to severe Crohn's disease (CD). We aimed to investigate how CD location effected the endoscopic and radiographic outcomes of VDZ. METHODS: This is a retrospective study from a tertiary care center, in patients (pts) with CD initiated on VDZ between July 2014 and January 2018. Pts had endoscopic or radiographic evaluation before (index examination) and >3 months after (follow-up examination) VZD initiation. Endoscopic remission/response was defined as resolution (remission) or significant improvement (response) of CD features with respect to the index examination. Endoscopic remission/response rate was compared between ileal and colonic disease. Improvement in radiographic features of small bowel (jejunum/ileum) CD was evaluated on magnetic resonance imaging or computed tomography scan. RESULTS: 140 pts were evaluated with a median follow-up 18 months (range: 3-55) (Table 1). 90% of the pts (n = 126) had prior anti-TNFα failure. 128 pts had endoscopic evaluation with a median follow up 27 months (3-55) (Table 2). Endoscopic remission/response rates between pts with ileal CD (62% [47/76]) and pts with colonic CD (49% [34/69]) were not statistically different (P = 0.13). Endoscopic remission/response rates in pts with isolated ileal CD (n = 59) and isolated colonic CD (n = 52) were similar (59% vs. 46% respectively; P = 0.17). Among pts with both ileal and colonic disease (n = 17), endoscopic remission/response rates were similar in ileal and colonic CD (71% vs. 59% respectively; P = 0.47). Endoscopic remission/response rate in the ileal disease in pts with prior ileocolic resection (ICR; n = 38) was lower than in pts with an intact anatomy (n = 22) (55.3% vs. 77.3% respectively; P = 0.05). Follow-up imaging was available in 30 pts with radiographic evidence of small bowel CD (median follow up 13 months [3-28]). Radiographic improvement was observed in 26.7% of pts. CONCLUSION: In this cohort of pts with CD, majority anti-TNF experienced, a significant number of pts had improvement in endoscopic features of CD on VDZ, regardless of CD location. Ileal disease in pts with prior ICR appears to be less responsive to VDZ as compared to in pts with an intact anatomy. Radiographic features of small bowel CD showed a low rate of improvement on VDZ. Further understanding of the impact of VDZ on small bowel CD is warranted.