Clinical and Experimental Gastroenterology (Jan 2024)

Magnetic Resonance Enterography Assessment of Transmural Healing with Vedolizumab in Moderate to Severe Crohn’s Disease: Feasibility in the VERSIFY Phase 3 Clinical Trial

  • Rimola J,
  • Colombel JF,
  • Bressler B,
  • Adsul S,
  • Siegelman J,
  • Cole PE,
  • Lindner D,
  • Danese S

Journal volume & issue
Vol. Volume 17
pp. 9 – 23

Abstract

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Jordi Rimola,1 Jean-Frédéric Colombel,2 Brian Bressler,3 Shashi Adsul,4 Jenifer Siegelman,5 Patricia E Cole,5 Dirk Lindner,4 Silvio Danese6 1IBD Unit, Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain; 2The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 3Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada; 4Takeda Pharmaceuticals International, Zurich, Switzerland; 5Takeda Pharmaceuticals International, Cambridge, MA, USA; 6Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, ItalyCorrespondence: Jordi Rimola, IBD Unit, Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain, Tel +34 932 275 400, Email [email protected]: The VERSIFY phase 3 trial in patients with Crohn’s disease (CD) treated with vedolizumab was the first to include a substudy that used a standardized magnetic resonance enterography (MRE) protocol to assess features of transmural inflammation (bowel edema and wall thickness) and extramural disease activity (enlarged lymph nodes).Patients and Methods: Patients received intravenous vedolizumab (300 mg) at weeks 0 (baseline), 2, and 6, and then every 8 weeks for 26 or 52 weeks. Post hoc analyses included a subpopulation with a Magnetic Resonance Index of Activity score of ≥ 7 in at least one bowel segment at baseline and at least one postbaseline MRE assessment. Changes in transmural inflammation, including intramural bowel edema and wall thickness, were evaluated. Patient-level and segment-level analyses were performed.Results: MRE images were evaluated in 27 patients with 83 evaluable bowel segments at baseline and week 26, and 13 patients with 38 evaluable segments at baseline, week 26, and week 52. At baseline, all patients had bowel wall edema and wall thickness of > 3 mm in at least one bowel segment. The proportion of patients with edema decreased at weeks 26 (17/27 [63.0%]) and 52 (4/13 [30.8%]) and the proportion with bowel wall thickness of > 3 mm decreased at weeks 26 (25/27 [92.6%]) and 52 (10/13 [76.9%]).Conclusion: In patients with CD treated with vedolizumab for 26 and 52 weeks, the number of patients, and bowel segments, with MRE-detected transmural inflammation was reduced. These results highlight the impact of vedolizumab on components of transmural inflammation in CD and demonstrate that using MRE in CD multicenter clinical trials is feasible.Trial Registration: ClinicalTrials.gov NCT02425111, April 23, 2015, http://www.clinicaltrials.gov NCT02425111; EU Clinical Trials Register EudraCT 2014– 003509-13, https://www.clinicaltrialsregister.eu. Keywords: vedolizumab, magnetic resonance enterography, Crohn’s disease, clinical trials, imaging

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