S1590 Rate of Vedolizumab Dose Escalation in Patients With Crohn’s Disease With a History of Anti-TNF Dose Escalation

Introduction: Patients (pts) with Crohn’s Disease (CD) may require dose escalation of an anti-tumor necrosis factor (TNF) agent during their treatment course, and some will require escalation of an alternative therapy, such as vedolizumab (VDZ). Data is sparse regarding rates of and pts’ response to VDZ escalation with a history of anti-TNF escalation. We sought to explore this relationship in CD pts previously exposed to anti-TNFs. Methods: A retrospective review of electronic health records from a tertiary care center between 2019 and 2024 was conducted to identify CD pts treated with VDZ and previously exposed to IFX or ADA. We defined anti-TNF escalation by either an increase of IFX from 5 mg/kg to 10 mg/kg or an increase in frequency to every 4 or 6 weeks, and ADA to weekly. VDZ escalation was defined as a frequency increase to every 4 or 6 weeks. Other data included concomitant thiopurine and steroid use, inflammatory markers, and Harvey-Bradshaw Index (HBI) at 0, 12, 16, and 20 weeks. We defined ability to recapture response by a decrease in the HBI of at least 3 points between weeks 0 and 20. Pt demographics, Crohn’s phenotype, location and duration of disease, related surgical history, and prior medications were also collected. Results: 89 pts (median age 41 yrs [range 23-79], 59.6% female, 85.4% White) with CD who were previously dose escalated on anti-TNF and then transitioned to VDZ were identified. In this cohort, 38 pts (43%) required VDZ dose escalation. Though there were no significant differences in disease history, treatment history or demographic variables across groups, numerically, pts that required dose escalation were more likely to have strictures (32.3% vs 19%), more likely to have ileocolonic disease (51.6% vs 41.4%), to have never smoked (80.6% vs 69%), and to have been exposed to steroids within 6 mo of VDZ start (29% vs 17.2%). 12 out of 31 pts had both Week 0 and Week 20 HBI values, and of those 12, 50% recaptured response following VDZ dose escalation. Conclusion: In those with a prior history of anti-TNF escalation, 43% had VDZ dose escalation. Pts more likely to need VDZ dose escalation were those with strictures, ileocolonic disease, nonsmokers, and recent steroid use. Of those who required dose escalation of VDZ, 50% had an adequate response. This study suggests close to 2 in 5 pts with a history of anti-TNF escalation may require dose escalation with VDZ. Future prospective studies in a larger cohort are needed to validate this finding.