Christina Ha, MD, on Anti-Integrins in IBD

Dr Ha recaps her presentation from the AIBD regional on the use of anti-integrins, particularly vedolizumab, for treating IBD. 

Christina Ha, MD, is a gastroenterologist and specialist in inflammatory bowel disease at the Mayo Clinic in Phoenix, Arizona.

Hi, my name is Christina Ha, I'm from the Mayo Clinic in Arizona, and I'm coming to you from Advances in IBD regionals. And I spoke about anti-integrins, and I really focused on vedolizumab because since 2019, there have been a lot of really important advances in vedolizumab and how we can integrate it in our practice in a smarter way.

So, the original GEMINI studies really demonstrated that vedolizumab is an effective treatment for moderate to severe Crohn's disease and ulcerative colitis. But what have we learned since the GEMINI studies? What we learned, especially in Crohn's disease, earlier initiation of vedolizumab for patients earlier diagnosed with Crohn's disease leads to better outcomes in terms of endoscopic response and mucosal healing.

But also, since then, there have been 2 important studies. One was the effectiveness vedolizumab in an important condition called pouchitis, which occurs after a patient has had a colectomy and now they're developing inflammation within their ileal pouch anal anastomosis, and there have been in a phase 4 clinical trial demonstrated important efficacy of vedolizumab to treat ileal pouchitis. Also, there's been data to show that vedolizumab may be effective for perianal Crohn’s disease in terms of decreasing fistula output as well as potentially even closing fistulas.

Now where in our therapeutic armamentarium is vedolizumab best suited for pouchitis as well as perianal Crohn’s disease relative to what we know with the anti-TNFs, interleukins, and now the integrins and JAK inhibitors? That remains to be said. But it is important to have concrete data that lets us know that it's an effective agent.

But also most importantly, within the last year, between 2023 and 2024, because of what's called the VISIBLE studies, we also now have subcutaneous vedolizumab. And these were demonstrated to be as effective as the infusion-based therapies for both Crohn's disease and ulcerative colitis. In fact, the FDA approval of vedolizumab subcutaneously for Crohn's disease just occurred relatively recently. So these are important options for our patients who may not necessarily have ready access to an infusion center who may prefer the convenience of subcutaneously injected vedolizumab.

We also talked about some important studies about patients who are already on standard dosing of infusion vedolizumab. Can they transition over to the self-injectable vedolizumab and still expect the same outcomes? And the great news is yes, the effectiveness and the safety are the same.

So what we learned is that vedolizumab is a potentially effective mechanism of action for patients with Crohn's disease if used early, for ileal pouchitis, for perianal Crohn's disease, and now in 2024, we have the subcutaneous versions available for our patients with ulcerative colitis and Crohn's disease.