Gabriels, R.Y. (Ruben Yannick) (2017) Does eosinophil count in intestinal biopsies prior to treatment predict response to Vedolizumab? thesis, Medicine.
Full text available on request.Abstract
Introduction: Crohn’s Disease (CD) and Ulcerative Colitis (UC) are idiopathic inflammatory bowel diseases (IBD). Symptoms consist of chronic, bloody diarrhea, abdominal and perianal pain. Current drugs are partly effective and have major limitations. Vedolizumab is a humanized monoclonal antibody against α4β7 integrin capable of blocking the migration of several immune cells including eosinophils across endothelium expressing MAdCAM-1. Vedolizumab is less costeffective than Infliximab (anti-TNFα inhibitor) and therefore, this antibody is in CD only accepted as a second line therapy after anti-TNF failure. We hypothesize that the number of eosinophils in the intestinal mucosa can predict the response to Vedolizumab therefore increasing the cost effectiveness of this antibody. Materials and Methods: This study retrospectively investigated the clinical response and remission rate to Vedolizumab in relation to CRP, blood counts and eosinophil count in the gut mucosa before start of the treatment in a real life IBD cohort (N=62). In 29 subjects we also compared the clinical response with the results of a second endoscopy performed during or shortly after treatment. Results: All included IBD patients are moderatelyseverely affected with 95% anti-TNFα failure prior to treatment with Vedolizumab. Vedolizumab showed a primary clinical response in 33 patients (53%) and 14 patients (23%) reached clinical remission, 29 patients (47%) did not experience any beneficial effect to treatment. Furthermore we found a significant increase in the number of eosinophils in the blood after treatment with Vedolizumab. There were no significant differences in blood and mucosa in eosinophil count between responders and non-responders. Conclusion: In this Dutch real life IBD cohort with 95% anti-TNFα failure, Vedolizumab showed a 53% primary response rate and 23% reached remission that could not be predicted by the presence of eosinophils in the intestinal mucosa prior to treatment.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Dijkstra, Prof. dr. G. and Daily Supervisor: and Trentadue, G. MD. MSc. and Department: Gastroenterology, UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:59 |
| Last Modified: | 25 Jun 2020 10:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1903 |
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