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Background and Aims: Vedolizumab, a humanised monoclonal antibody for the treatment of inflammatory bowel disease, selectively blocks gut lymphocyte trafficking. This may reduce the risk of respiratory tract infections [RTIs] compared with systemic immunosuppressive therapies. To assess this possibility, we evaluated the rates of RTIs in clinical trials of vedolizumab. Methods: Patient-level data from Phase 3 randomised controlled trials [RCTs] of vedolizumab in ulcerative colitis [UC; GEMINI 1] and Crohn's disease [CD; GEMINI 2], and a long-term safety study [UC and CD] were pooled. Cox proportional hazards models were used to estimate the incidence of upper RTIs [URTIs] and lower RTIs [LRTIs] with adjustment for significant covariates. Results: In the RCTs [n = 1731 patients], the incidence of URTIs was numerically higher in patients receiving vedolizumab compared with those receiving placebo, although this difference was not statistically significant (38.7 vs 33.0 patients per 100 patient-years; hazard ratio [HR] 1.12; 95% confidence interval [CI]: 0.83-1.51; p = 0.463). The rate of LRTIs, including pneumonia, was numerically lower in the vedolizumab versus the placebo group: this difference was not statistically significant (7.7 vs 8.5 per 100 patient-years [HR 0.85; 95% CI: 0.48-1.52; p = 0.585]). Both URTIs and LRTIs were more frequent in patients with CD compared with UC. Most RTIs in patients receiving vedolizumab were not serious and did not require treatment discontinuation. Conclusions: Vedolizumab therapy was not associated with an increased incidence of respiratory tract infection compared with placebo.

Original publication

DOI

10.1093/ecco-jcc/jjy047

Type

Journal article

Journal

J Crohns Colitis

Publication Date

30/07/2018

Volume

12

Pages

905 - 919

Keywords

Adult, Antibodies, Monoclonal, Humanized, Bronchitis, Colitis, Ulcerative, Crohn Disease, Female, Gastrointestinal Agents, Humans, Incidence, Male, Middle Aged, Nasopharyngitis, Pneumonia, Proportional Hazards Models, Randomized Controlled Trials as Topic, Respiratory Tract Infections, Young Adult