S1764 Efficacy and Safety of Vedolizumab for Prevention of Postoperative Recurrence in Crohn’s Disease: A Systematic Review and Meta-Analysis

Introduction: Postoperative recurrence (POR) remains a significant challenge in Crohn’s disease (CD) patients with high-risk features. Although anti-tumor necrosis factor (TNF) agents are currently the most validated biologic therapies in this setting, vedolizumab, a gut-selective integrin antagonist, has been studied in this clinical setting. However, its real-world efficacy and safety in preventing POR remain unclear. We conducted a single-arm proportional meta-analysis to evaluate rates of endoscopic, clinical, and biologic recurrence, as well as adverse events in CD patients receiving vedolizumab postoperatively. Methods: We systematically searched MEDLINE, EMBASE, and Scopus from inception through May 2025 for studies assessing vedolizumab for prevention of POR in CD patients. Inclusion criteria were postoperative CD patients treated with vedolizumab with reported rates of clinical, endoscopic, or biologic recurrence. A total of 5 studies met inclusion criteria. We extracted pooled proportions of outcomes using a random-effects model. Definitions of recurrence followed each study’s protocol, including modified Rutgeerts scores for endoscopic POR, Harvey-Bradshaw Index or physician assessment for clinical POR, and C-reactive protein or fecal calprotectin for biologic POR. Results: Across 5 studies, 187 patients were included with 43.8% females. Most patients had prior anti-TNF exposure and at least one high-risk feature for recurrence, including prior resections, penetrating disease, or active smoking. The pooled rate of clinical POR was 40.4% (95% CI: 18.7-62.0), endoscopic POR 43.1% (95% CI: 26.4-59.9), and biologic POR 67.4% (95% CI: 56.3-78.5). Adverse events occurred in only 2.9% of patients (95% CI: 0.5-5.3). Conclusion: Vedolizumab shows moderate effectiveness in preventing postoperative recurrence in Crohn’s disease, with clinical and endoscopic recurrence near 40% and few adverse events. Controlled prospective trials are needed to further define its role and optimize postoperative management strategies in CD.