Examining the Long-term Clinical Evidence of Therapies for Inflammatory Bowel Disease in Bio-naïve Patients - Episode 5
Anita Afzali, MD, David Hudesman, MD, Millie Long, and Miguel Regueiro, MD, discuss Vedolizumab and Risankizumab as treatments for Crohn’s Disease (CD).
David Hudesman, MD: Miguel brought up vedo [vedolizumab]. Anita, are you using vedo in Crohn's? How are you using it?
Anita Afzali, MD: Good question. Typically we say, vedolizumab mighttake longer to be effective in Crohn's disease, and in my experience, and I'd love to see what my colleague says as well, as we stratify them appropriately, we're encountering patients who have more of that moderate or multisegmental or perianal involvement etc. In those situations, I do not consider vedolizumab in Crohn's disease for these patients. One segment, as Miguel mentioned, colonic primarily in that situation for looking at other factors, patient-related factors, disease-related factors, payer's access, etc, I may consider it, but typically I shy away from vedolizumab for Crohn's disease.
David Hudesman, MD: I think a lot of it is where we're seeing the patients. So if we're seeing them on the end versus those more moderate, luminal, inflammatory, colonic, I think that's a rule, where for different factors that it may be a good option for the patient.
Miguel Regueiro, MD: Just to add to that, the way I like to say it is, especially to the patient in the office, if they're on the milder end of moderate, that's a place where maybe first line vedo, single segment colon. Safety's a big concern, if you want right now in the United States for them to get infusion only, maybe in the future we'll have that Sub-Q option. That's perfect. But I also agree with Anita, that's the sweet spot for vedo for Crohn's disease.
David Hudesman, MD: And then risankizumab is our newest agent for Crohn's. How has that affected your practice and prescribing patterns?
Millie Long, MD, MPH: Absolutely. I've used risankizumab and I think that there are reasonable data with riza even in TNF-exposed patients in terms of capturing a good response in remission. I think it can be used in either a bio-naive population as we're discussing today or in a TNF-exposed population. I don't have enough data yet to compare it to IL 12/23. I think that the real-world data are needed to help in that scenario. Obviously in psoriasis there are improved outcomes looking at an IL 23p19 as compared to an IL 12/23, but we don't know that yet in inflammatory bowel disease. For me, I kind of it as interchangeable at this point, whether I'm going to be using an IL 12/23 or an IL 23. And I think more data will help us in terms of trying to understand if there is incremental benefit there.
David Hudesman, MD: We've seen in some earlier studies where if somebody's had a response and lost a response to ustekinumab, then you could still go to risankizumab, but which one should we use first? We just don't have that data quite yet.
Transcript edited for clarity.