Vedolizumab as the first line of biologic therapy for ulcerative colitis and Crohn's disease - a systematic review with meta-analysis

Background: The efficacy and safety of vedolizumab in bio-naive patients with ulcerative colitis (UC) and Crohn's disease (CD) remain unknown. Aims: To perform a meta-analysis regarding vedolizumab as first line of biological therapy for UC or CD. Methods: A systematic review of Medline, EMBASE, and Cochrane databases per December 2020 was undertaken. Meta-analysis was conducted using random-effects models. Results: This systematic review identified 79 eligible studies with 4,520 and 3,494 bio-naive patients with UC and CD, respectively, and 8,105 and 11,140 bio-exposed patients. Among bio-naive patients with UC, a total of 40.0% (95%CI 27.0-54.0, I-2 =86%) and 63.9% (95%CI 47.0-79.2, I-2 =36%) achieved clinical remission at weeks 14 and 52, respectively. The corresponding rates in CD were 54.0% (95%CI 42.0-66.0, I-2=23%), and 61.7% (95%CI 55.2-68.1, I-2 =0%). Bio-naivety was associated with a higher probability of clinical remission at week 52 in UC (relative risk (RR)=1.32 (95%CI 1.14-1.53)), while this was only apparent until week 26 in CD (RR=1.60 (95%CI 1.30-1.95)). Finally, bio-naive UC patients had a lower risk of serious adverse events (RR=0.29 (95%CI 0.09-0.95)). Conclusion: Vedolizumab was found to have a favorable efficacy and safety profile in bio-naive patients with UC and CD. The findings have implications in the management of IBD. (c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.