Dear Editor,
We read with great interest the study by Azzam et al.[1] on the effectiveness of vedolizumab in advanced therapy-experienced ulcerative colitis (UC) patients. We commend the authors for addressing an important gap in literature. The authors utilized retrospective electronic chart review to analyze 153 patients, and the study outcomes were assessed using well-defined criteria such as the Patient Simple Clinical Colitis Activity Index (P-SCCAI). The inclusion of logistic regression analysis to identify predictors of remission adds valuable insights to clinicians.
However, certain methodological aspects warrant attention. The study was conducted in two tertiary care centers, which may not reflect the practices and patient demographics in community hospitals. For instance, only 3% of patients included had E1 disease, suggesting that these cases of UC, typically managed in nontertiary settings, were under-represented.
On that same note, an intriguing observation was that 68% of patients had a disease duration of fewer than 10 years but had nonetheless progressed from conventional therapies to tumor necrosis factor inhibitors and subsequently vedolizumab. There was a shorter time frame compared to what one would expect in a community practice.[2] This indicates that they have been receiving care with a treat-to-target strategy, highlighting the proactive approach to disease management in these centers. However, it would be valuable to assess whether the results in this study are similar in other settings with varying resources and clinical practices.
Another notable aspect is the inclusion of patients who failed adalimumab (13%), an agent known to have lower efficacy in UC.[3] This raises the question of whether these patients should have been considered as biologic-naïve. Adalimumab’s limited effectiveness in UC might skew interpretations of prior biologic failure. Clarifying this distinction would refine the study’s results.
The finding of higher clinical remission rates among female patients is thought-provoking and difficult to explain. One potential hypothesis is the possible body mass index differences among study participants which may have contributed to varying pharmacokinetics or disease responses.[4]
Finally, the study did not include an assessment of fecal calprotectin, an important marker of disease activity that could complement the biochemical and clinical outcomes reported.
Despite these limitations, this study represents a valuable contribution to the growing body of evidence on vedolizumab in real-world settings. We applaud Azzam et al. for their meaningful work.
Conflicts of interest
There are no conflicts of interest.
Sincerely,
Funding Statement
Nil.
REFERENCES
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