Review Article

Predictors of Response to Vedolizumab and Ustekinumab in Inflammatory Bowel Disease

A. Barré; J.-F. Colombel; R. Ungaro

Disclosures

Aliment Pharmacol Ther. 2018;47(7):896-905. 

In This Article

Conclusion

In this review, we found that multiple factors have been associated with initial and long–term response to vedolizumab and ustekinumab in IBD. A summary of major predictors of response to vedolizumab and ustekinumab compared to anti–TNF agents is provided in Figure 1. However, the literature is sometimes inconsistent and missing. Overall, patients with less severe disease (by clinical and biochemical indices), naïve to anti–TNF therapy and higher induction drug levels are more likely to respond to treatment, especially with vedolizumab. Intriguing emerging data suggest that microbiome composition may be a marker of vedolizumab response. Future research is needed to develop a comprehensive predictive model incorporating these clinical, pharmacological and microbiome–related data to accurately classify treatment response. Validated serological and genomic markers of response to these agents are currently lacking. Finally, contrary to what is described with anti–TNF agents, immunogenicity appears to play less of a role in loss of response with vedolizumab and ustekinumab. Further head–to–head trials and observational translational studies are needed to help define the best positioning of new novel biological agents.

Figure 1.

Comparison of predictors of response currently available in the literature for anti–TNF therapies, vedolizumab and ustekinumab in Crohn's disease (A) and ulcerative colitis (B)

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