LOVE-CD: Vedolizumab yields better outcomes in early than in late CD

Vedolizumab had a better safety profile and was more efficacious in participants with early Crohn’s disease (CD) than in those with late disease, according to the final results of the prospective LOVE-CD trial.

Vedolizumab is an efficacious treatment for inducing and maintaining remission in CD [1]. However, prospective data regarding its efficacy in patients with early CD is lacking. Previous studies have shown that TNF inhibitors are more efficacious in patients with a shorter disease duration [2].

Prof. Geert D’Haens (Amsterdam University Medical Center, the Netherlands) and colleagues hypothesised that vedolizumab might lead to better outcomes when administered to patients with early CD than those with late CD [3]. The prospective LOVE-CD study (EudraCT 2014-005376-29) enrolled 260 participants with moderately to severely active CD. Among these, 86 had early CD (<2 years) and 174 had late CD (>2 years). All participants received standard induction and maintenance dosing with intravenous vedolizumab 300 mg up to week 52. The primary endpoint was clinical and endoscopic remission at weeks 26 and 52.

The primary endpoint was met by 31% of the participants in the early CD group and 9% of those in the late CD group (delta 22%; P=0.001). Furthermore, the absence of ulcers at week 52 was reported in 48% of participants receiving vedolizumab during early disease and 23% during late disease (P<0.001). Likewise, endoscopic response rates at week 52 favoured the early disease group (57% vs 36%; P<0.001).

In addition to the benefits in efficacy outcomes for participants with early disease, vedolizumab was also associated with better safety outcomes in this subpopulation. The rates of serious adverse events were 27% for the late CD arm and 5% for the early CD arm (P<0.0001). “The infection rate was higher in the late CD arm than in the early CD arm (7% vs 1%),” said Prof. D’Haens. “This is probably not a consequence of vedolizumab treatment but may be related to the use of concomitant medication and perhaps more severe disease,” he reasoned.

“In this study among participants with moderate-to-severe CD, vedolizumab was more efficacious and safer in early disease than in late disease,” concluded Prof. D’Haens.

1. 
   
   1. Sandborn WJ, et al. N Engl J Med 2013;369:711-721.
   2. D’Haens G, et al. Lancet. 2008;371:660-667.
   3. D’Haens G, et al. Vedolizumab treatment in Crohn’s disease is safer and more effective in early than in late disease: final results of the LOVE-CD trial. OP147, UEG Week 2024, 12–15 October, Vienna, Austria.

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Posted on 28 November 2024