Takeda Pharmaceutical Company Limited [TSE:4502], (“Takeda”) today announced the presentation of eight real-world analyses supporting the effectiveness and safety of Entyvio® (vedolizumab) for the treatment of adults with moderately to severely active ulcerative colitis (UC) and Crohn’s disease (CD). The data were presented at the 2017 Digestive Disease Week® (DDW) annual scientific meeting in Chicago, Illinois. Two analyses of real-world data from the U.S. VICTORY (Vedolizumab for Health OuTComes in InflammatORY Bowel Diseases) consortium support findings from the pivotal GEMINI clinical trial program demonstrating the efficacy of Entyvio®.1,2,3,4,5,6,7,8,9,10,11,12,13,14,15
A cohort analysis (abstract #1853) from the VICTORY consortium concerning predictors of clinical and endoscopic response examined mucosal healing, clinical response and remission and steroid-free response and remission in 180 patients with moderately to severely active UC treated with vedolizumab.15 Clinical response and remission were based on the physician global assessment score, a 5- or 6-point scoring system used to assess disease severity.16 In this large, multi-center cohort, a substantial proportion of patients achieved either mucosal healing defined as a Mayo endoscopic subscore of 0 or 1 (77 percent), clinical remission (51 percent) or steroid-free remission (41 percent) by 12 months in routine practice.
“The real-world evidence from the VICTORY consortium supports the data observed in the pivotal GEMINI clinical trial program, further demonstrating the effectiveness of vedolizumab,” said Parambir Dulai, M.D., Research Fellow, University of California San Diego, and Lead Investigator of the VICTORY consortium analyses.
An additional analysis (abstract #1785) from the VICTORY consortium examined the rates and predictors of progression to surgery and the proportion of patients with inflammatory bowel disease (IBD) requiring surgery 6 or 12 months after vedolizumab induction in 742 patients (UC=306, CD=436).13 Investigators observed trends toward a decline in surgical rates over time depending on when vedolizumab was initiated over a two year period. The reasons for these observations are unknown, and further prospective studies are required to characterize these findings.
“Real-world evidence plays an important role in helping healthcare providers evaluate a therapy’s effectiveness and safety in routine medical practice against clinical trial results, and the VICTORY consortium provides valuable clinical knowledge for the IBD community,” said Professor William Sandborn, M.D., Chief, Division of Gastroenterology, University of California San Diego.
The VICTORY consortium is a collaboration of 10 leading IBD centers from across the U.S. and represents the first large, well-characterized cohort of patients taking Entyvio® in a real-world setting in the U.S. Patients included in the consortium were identified at each site through electronic medical record searches, review of clinical records, and/or queries of infusion center records. Approximately 900 UC and CD patients are now included in the consortium database, which was started when Entyvio® was launched in the U.S. in 2014.15
In addition to real-world analyses, other Takeda-sponsored posters presented at the DDW meeting include evaluations of long-term effectiveness and safety of Entyvio® in patients with UC and CD, as well as post-hoc analyses of GEMINI I and II data.1,2,3,4,5,6,7,8,9,10,11,12,13,14,15 For a full list of poster titles and authors, visit www.ddw.org/attendee-planning/online-planner.
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Vedolizumab is a prescription medicine approved for adults with moderate to severe ulcerative colitis (UC) or Crohn's disease (CD).17,18 In people with UC and CD, there’s an increased number of inflammatory white blood cells entering the mucosal lining of the bowel.19 The presence of these inflammatory cells can lead to the symptoms most commonly seen in people who have UC or CD.20,21,22 Vedolizumab is designed to reduce this inflammation by blocking the movement of the white blood cells into the inflamed gut tissue.19Mucosal addressin cell adhesion molecule 1 (MAdCAM-1) is preferentially expressed on the endothelial lining of blood vessels in the lymphoid tissue of the bowel.23
The safety and efficacy of Entyvio® is supported by the results of the GEMINI clinical trial program. These Phase 3 studies involved 2,400 individuals with ulcerative colitis (UC) or Crohn’s disease (CD) who were recruited from nearly 40 countries.24,25,26,27
The GEMINI program consists of four studies – a placebo-controlled study of vedolizumab induction and maintenance treatment in patients with moderately to severely active UC (GEMINI I), a placebo-controlled study of vedolizumab induction and maintenance treatment in patients with moderately to severely active CD (GEMINI II), a placebo-controlled study of vedolizumab induction in patients with moderately to severely active CD (GEMINI III) and an open-label long-term safety study of vedolizumab in patients with either CD or UC (GEMINI long-term safety).24,25,26,27
Ulcerative colitis (UC) and Crohn’s disease (CD) are two of the most common forms of inflammatory bowel disease (IBD).28,29 Both UC and CD are chronic, relapsing, remitting, inflammatory conditions of the gastrointestinal (GI) tract that are often progressive in nature.20,30 UC only involves the large intestine as opposed to CD which can affect any part of the GI tract from mouth to anus.22,31 CD can also affect the entire thickness of the bowel wall, while UC only involves the innermost lining of the large intestine.22 UC commonly presents with symptoms of abdominal discomfort, loose bowel movements, including blood or pus.22,32 CD commonly presents with symptoms of abdominal pain, diarrhea and weight loss.20 The cause of UC or CD is not fully understood, however recent research suggests hereditary, genetics, environmental factors and/or an abnormal immune response to microbial antigens in genetically predisposed individuals can lead to UC or CD.22,33,34
Vedolizumab is indicated for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumor necrosis factor-alpha (TNFα) antagonist.
Vedolizumab is indicated for the treatment of adult patients with moderately to severely active Crohn’s disease who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumor necrosis factor-alpha (TNFα) antagonist.
Hypersensitivity to the active substance or to any of the excipients.
Vedolizumab should be administered by a healthcare professional prepared to manage hypersensitivity reactions including anaphylaxis, if they occur. Appropriate monitoring and medical support measures should be available for immediate use when administering vedolizumab. Observe patients during infusion and until the infusion is complete.
In clinical studies, infusion-related reactions (IRR) and hypersensitivity reactions have been reported, with the majority being mild to moderate in severity. If a severe IRR, anaphylactic reaction, or other severe reaction occurs, administration of vedolizumab must be discontinued immediately and appropriate treatment initiated (e.g., epinephrine and antihistamines). If a mild to moderate IRR occurs, the infusion rate can be slowed or interrupted and appropriate treatment initiated (e.g., epinephrine and antihistamines). Once the mild or moderate IRR subsides, continue the infusion. Physicians should consider pre-treatment (e.g., with antihistamine, hydrocortisone and/or paracetamol) prior to the next infusion for patients with a history of mild to moderate IRR to vedolizumab, in order to minimize their risks.
Vedolizumab is a gut-selective integrin antagonist with no identified systemic immunosuppressive activity. Physicians should be aware of the potential increased risk of opportunistic infections or infections for which the gut is a defensive barrier. Vedolizumab treatment is not to be initiated in patients with active, severe infections such as tuberculosis, sepsis, cytomegalovirus, listeriosis, and opportunistic infections until the infections are controlled, and physicians should consider withholding treatment in patients who develop a severe infection while on chronic treatment with vedolizumab. Caution should be exercised when considering the use of vedolizumab in patients with a controlled chronic severe infection or a history of recurring severe infections. Patients should be monitored closely for infections before, during and after treatment. Before starting treatment with vedolizumab, screening for tuberculosis may be considered according to local practice. Some integrin antagonists and some systemic immunosuppressive agents have been associated with progressive multifocal leukoencephalopathy (PML), which is a rare and often fatal opportunistic infection caused by the John Cunningham (JC) virus. By binding to the α4β7 integrin expressed on gut-homing lymphocytes, vedolizumab exerts an immunosuppressive effect on the gut. Although no systemic immunosuppressive effect was noted in healthy subjects, the effects on systemic immune system function in patients with inflammatory bowel disease patients is not known. No cases of PML were reported in clinical studies of vedolizumab however, healthcare professionals should monitor patients on vedolizumab for any new onset or worsening of neurological signs and symptoms, and consider neurological referral if they occur. If PML is suspected, treatment with vedolizumab must be withheld; if confirmed, treatment must be permanently discontinued. Typical signs and symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body, clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. The progression of deficits usually leads to death or severe disability over weeks or months.
The risk of malignancy is increased in patients with ulcerative colitis and Crohn’s disease. Immunomodulatory medicinal products may increase the risk of malignancy.
No vedolizumab clinical trial data are available for patients previously treated with natalizumab. Caution should be exercised when considering the use of vedolizumab in these patients. No clinical trial data for concomitant use of vedolizumab with biologic immunosuppressants are available. Therefore, the use of vedolizumab in such patients is not recommended.
Prior to initiating treatment with vedolizumab all patients should be brought up to date with all recommended immunizations. Patients receiving vedolizumab may receive non-live vaccines (e.g., subunit or inactivated vaccines) and may receive live vaccines only if the benefits outweigh the risks.
Adverse Reactions include: Nasopharyngitis, Bronchitis, Upper respiratory tract infection, Influenza, Sinusitis, Headache, Oropharyngeal pain, Cough, Nausea, Rash, Pruritus, Arthralgia, Back pain, Pain in extremities, and Pyrexia.
Please consult with your local regulatory agency for approved labeling in your country.
For EU audiences, please see the Summary of Product Characteristics (SmPC) for ENTYVIO.
More than 70 million people worldwide are impacted by gastrointestinal (GI) diseases, which can be complex, debilitating and life-changing.35 Takeda is driven to improving the lives of patients with GI diseases through innovative medicines, dedicated patient disease management support and the evolution of the healthcare environment. Takeda is leading in gastroenterology through the delivery of innovative medicines in areas associated with high unmet needs, such as inflammatory bowel disease, GI acid-related diseases and GI motility disorders. Our GI research & development team is also exploring solutions in celiac disease and nonalcoholic steatohepatitis (NASH), as well as scientific advancements through microbiome therapies. With more than 25 years of experience in this area, our broad approach to treating many diseases that impact the GI system and our global network of collaborators, Takeda aims to advance how patients manage their disease.
Takeda Pharmaceutical Company Limited is a global, R&D-driven pharmaceutical company committed to bringing better health and a brighter future to patients by translating science into life-changing medicines. Takeda focuses its research efforts on oncology, gastroenterology and central nervous system therapeutic areas. It also has specific development programs in specialty cardiovascular diseases as well as late-stage candidates for vaccines. Takeda conducts R&D both internally and with partners to stay at the leading edge of innovation. New innovative products, especially in oncology and gastroenterology, as well as its presence in emerging markets, fuel the growth of Takeda. More than 30,000 Takeda employees are committed to improving quality of life for patients, working with our partners in health care in more than 70 countries. For more information, visit http://www.takeda.com/news.
1 Loftus EV, et al. Long-term effectiveness and safety of vedolizumab in patients with ulcerative colitis: 5-year cumulative exposure of GEMINI 1 completers rolling into the GEMINI open-label extension study. Digestive Disease Week (DDW) 2017. Poster #1934.
2 Vermeire S, et al. Long-term effectiveness and safety of vedolizumab in patients with Crohn’s disease: 5-year cumulative exposure of GEMINI 2 completers rolling into the GEMINI open-label extension study. Digestive Disease Week (DDW) 2017. Poster #1931.
3 Feagan BG, et al. Effect of vedolizumab treatment on extraintestinal manifestations in patients with Crohn’s disease: A GEMINI 2 post hoc analysis. Digestive Disease Week (DDW) 2017. Poster #1921.
4 Bokemeyer B, et al. Sustained remission with vedolizumab in patients with moderately to severely active ulcerative colitis: A GEMINI 1 post hoc analysis of Week 14 remitters. Digestive Disease Week (DDW) 2017. Poster #1939.
5 Bhayat F, et al. Post-marketing experience of vedolizumab in inflammatory bowel disease: Analysis of pneumonia and other respiratory tract infections. Digestive Disease Week (DDW) 2017. Poster #1876.
6 Feagan BG, et al. Incidence of pneumonia and other respiratory tract infections with vedolizumab treatment for inflammatory bowel disease: Clinical trial experience. Digestive Disease Week (DDW) 2017. Poster #1877.
7 Ng SC, et al. Vedolizumab clinical and post-marketing safety experience of opportunistic infections. Digestive Disease Week (DDW) 2017. Poster #1865.
8 Schreiber S, et al. Real world effectiveness of vedolizumab over one year in inflammatory bowel disease: a meta-analysis. Digestive Disease Week (DDW) 2017. Poster #1700.
9 Alam N, et al. Comparative effectiveness of flares, hospitalisations, and corticosteroid use among biologic-naïve inflammatory bowel disease patients receiving vedolizumab versus infliximab during one-year. Digestive Disease Week (DDW) 2017. Poster #1914.
10 Patel H, et al. Discontinuation of corticosteroids among Ulcerative Colitis patients treated with vedolizumab in the United States (US). Digestive Disease Week (DDW) 2017. Poster #1930.
11 Patel H, et al. Discontinuation of corticosteroids among Crohn’s disease patients treated with vedolizumab in the United States (US). Digestive Disease Week (DDW) 2017. Poster #1931.
12 Ylisaukko-oja T, et al. Evaluation of treatment persistence of vedolizumab among Finnish inflammatory bowel disease (IBD) patients in real-life clinical practice (FINVEDO). Digestive Disease Week (DDW) 2017. Poster #1934.
13 Koliani-Pace J et al. Rates and predictors of surgery in inflammatory bowel disease patients initiating vedolizumab therapy: results from the VICTORY consortium. Digestive Disease Week (DDW) 2017. Poster #1785.
14 Khan N, et al. Advanced age is an independent predictor of infections among inflammatory bowel disease patients: A retrospective database analysis. Digestive Disease Week (DDW) 2017. Oral presentation #18.
15 Dulai PS, et al. Predictors of clinical and endoscopic response with vedolizumab for the treatment of moderately-severely active ulcerative colitis: Results from the US VICTORY consortium. Digestive Disease Week (DDW) 2017. Poster #1853.
16 Pascoe VL, Enamandram M, Corey KC, et al. Using the physician global assessment in a clinical setting to measure and track patient outcomes. JAMA Dermatology.2015;151:375-381.
17 Entyvio® Patient Information Leaflet. Takeda Pharmaceuticals. June 2016.
18 Entyvio® Summary of Product Characteristics. Takeda Pharmaceuticals. June 2014.
19 Soler D, Chapman T, Yang LL, et al. The binding specificity and selective antagonism of vedolizumab, an anti-α4β7 integrin therapeutic antibody in development for inflammatory bowel diseases. J Pharmacol Exp Ther. 2009;330:864-875.
20 Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012; 380:1590-1605.
21 Xavier RJ, Podolski DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature. 2007; 448: 427-434.
22 The facts about inflammatory bowel disease. Crohn’s and Colitis Foundation. http://www.crohnscolitisfoundation.org/assets/pdfs/ibdfactbook.pdf. Published November 2014. Accessed April 24, 2017.
23 Briskin M, Winsor-Hines D, Shyjan A, et al. Human mucosal addressin cell adhesion molecule-1 is preferentially expressed in intestinal tract and associated lymphoid tissue. Am J Pathol. 1997;151:97-110.
24 Study of vedolizumab (MLN0002) in patients with moderate to severe ulcerative colitis (GEMINI I). ClinicalTrials.gov Web site. http://www.clinicaltrials.gov/ct2/show/NCT00783718?term=vedolizumab&rank=5. Updated June 19, 2014. Accessed April 24, 2017.
25 Study of vedolizumab (MLN0002) in patients with moderate to severe Crohn’s disease (GEMINI II). ClinicalTrials.gov Web site. http://www.clinicaltrials.gov/ct2/show/NCT00783692?term=vedolizumab&rank=2. Updated June 19, 2014. Accessed April 24, 2017.
26 Study of vedolizumab in patients with moderate to severe Crohn’s disease (GEMINI III). ClinicalTrials.gov Web site. http://www.clinicaltrials.gov/ct2/show/NCT01224171?term=vedolizumab&rank=4. Updated June 19, 2014. Accessed April 24, 2017.
27 An open-label study of vedolizumab (MLN0002) in patients with ulcerative colitis and Crohn’s disease (GEMINI LTS). ClinicalTrials.gov Web site. http://www.clinicaltrials.gov/ct2/show/NCT00790933?term=vedolizumab&rank=3. Updated February 17, 2017. Accessed April 24, 2017.
28 What is Inflammatory Bowel Disease (IBD)? Centers for Disease Control and Prevention Web site. https://www.cdc.gov/ibd/. Accessed April 24, 2017.
29 Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology. Lancet. 2007;369: 1627-1640.
30 Torres J, Billioud V, Sachar DB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis as a progressive disease: the forgotten evidence. Inflamm Bowel Dis. 2012;18: 1356-1363.
31 Ingle SB, Adgaonkar BD, Jamadar NP, Siddiqui S, Hinge CR. Crohn’s disease with gastroduodenal involvement: Diagnostic approach. World J Clin Cases. 2015; 3: 479-483.
32 Sands BE. From symptom to diagnosis: clinical distinctions among various forms of intestinal inflammation. Gastroenterology. 2004; 126; 1518-1532.
33 Bloom SM, Bijanki VN, Nava GM, et al. Commensal Bacteroides species induce colitis in host-genotype-specific fashion in a mouse model of inflammatory bowel disease. Cell Host Microbe. 2011; 9: 390-403.
34 Kaser A, Zeissig S, Blumberg RS. Genes and environment: How will our concepts on the pathophysiology of IBD develop in the future? Dig Dis. 2010; 28: 395-405.
35 Digestive Health. University of Miami Hospital. http://umiamihospital.com/service-lines/digestive-health. Accessed April 24, 2017.