Changing the Game in Ulcerative Colitis: The Impact of Gut-Selective Therapy

This satellite symposium took place on 17th February 2017 as part of the European Crohn’s and Colitis Organisation (ECCO) Congress in Barcelona, Spain

Chairperson: Jean-Frédéric Colombel1
Speakers: Jean-Frédéric Colombel,1 Brian G. Feagan,2 Stefan Schreiber3

1. Icahn School of Medicine at Mount Sinai, New York City, New York, USA
2. Western University, London, Ontario, Canada
3. Clinic of Internal Medicine I, Christian-Albrechts-University, Kiel, Germany

Disclosure: Prof Jean-Frédéric Colombel has acted as a consultant or advisory board member for AbbVie, ABScience, Amgen, Bristol Myers Squibb, Celltrion, Danone, Ferring, Genentech, Giuliani SPA, Given Imaging, Janssen, Immune Pharmaceuticals, Medimmune, Merck & Co, Millennium Pharmaceuticals Inc., Neovacs, Nutrition Science Partners Limited, Pfizer Inc., Prometheus Laboratories, Protagonist, Receptos, Sanofi, Schering Plough Corporation, Second Genome, Shire, Takeda Pharmaceuticals International GmbH, Teva Pharmaceuticals, Tigenix, UCB Pharma, Vertex, and Dr. August Wolff GmbH & Co. He has also been a speaker for AbbVie, Falk, Ferring, Janssen, Nutrition Science Partners Ltd, and Takeda Pharmaceuticals International GmbH. Prof Brian G. Feagan has worked with Abbott/AbbVie, Actogenix, Akros, Albireo Pharma, Allergan, Amgen, Astra Zeneca, Atlantic Pharma, Avaxia Biologics Inc, Avir Pharma, Baxter Healthcare Corp, Biogen Idec, Boehringer-Ingelheim, Bristol-Myers Squibb, Calypso Biotech, Celgene, Celltech, Elan/ Biogen, EnGene, Ferring Pharma, Roche/Genentech, Galapagos, GiCare Pharma, Gilead, Given Imaging Inc, Kakko Kirin Co Ltd, Lexicon, Lilly, Lycera BioTech, MedImmune Ltd, Merck, Mesoblast Pharma, Millennium, Nektar, Nestle, Novartis, Novo Nordisk, Pfizer, Prometheus Therapeutics and Diagnostics, Protagonist, Receptos, Roche/Genentech, Salix Pharma, Sanofi, Santarus Inc, Serono, Shire, Sigmoid Pharma, Synergy Pharma Inc, Takeda Pharmaceuticals International GmbH, Teva Pharma, TiGenix, Tillotts, UCB Pharma, Vertex Pharma, Vivelix Pharma, VHsquared Ltd, Warner-Chilcott, Wyeth, Zealand, and Zyngenia. Prof Stefan Schreiber has acted as consultant for AbbVie, BMS, Boehringer Ingelheim, Ferring, Janssen, Medimmune/AstraZeneca, MSD, Pfizer, Sanofi, Takeda Pharmaceuticals International GmbH, and UCD. He has received honoraria for lectures from AbbVie, Ferring, MSD, Takeda Pharmaceuticals International GmbH, and UCB.
Acknowledgements: Writing assistance was provided by Janet Fricker.
Support: The publication of this article was funded by Takeda Pharmaceuticals International GmbH. The views and opinions expressed are those of the speakers and not necessarily of Takeda.
Citation: EMJ Gastroenterol. 2017;6[Suppl 8]:2-10.

Meeting Summary

Given the progressive nature of ulcerative colitis (UC), Prof Colombel argued that effective therapy is warranted early in the disease course, especially for patients judged at a high risk of colectomy. To slow disease progression clinicians should aim for complete recovery or absence of inflammation in the gut mucosa. This goal has recently been recommended by the US Food and Drug Administration (FDA) who advised that endoscopy should be used in conjunction with histology for the assessment of mucosal healing in UC.

Considering remission in UC, Prof Feagan explained that while there is clear evidence that endoscopic remission is associated with better outcomes, challenges remain in achieving remission with current agents. Studies show utility for incorporating histopathological activity into clinical trials, but there are concerns regarding the lack of agreement among pathologists. Two newly validated indices for evaluating histologic disease activity in UC (Robarts Histopathology Index [RHI] and Nancy Histopathology Index) open the way for histopathology to be introduced in early drug development.

Prof Schreiber reviewed vedolizumab, a gut-selective α4β7 integrin antagonist recommended by the European Crohn’s and Colitis Organisation (ECCO) guidelines as a first-line biologic therapy for the treatment of moderate-to-severe UC. Data from clinical trials showed that vedolizumab has the greatest efficacy in anti-tumour necrosis factor (TNF)-naïve patients and early in the disease course. Histologic healing, reported in >50% of UC patients with endoscopic remission taking vedolizumab, is likely to be a new endpoint in clinical trials. Vedolizumab has a favourable risk-benefit profile, with >77,382 patient years of post-marketing exposure worldwide.1

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