Type of publication:
Journal article
Author(s):
Bodger, Keith; Booker, Cheryl; Taylor, Frederick; Ahmad, Tariq; Bloom, Stuart; *Butterworth, Jeffrey; Kok, Klaartje; Lobo, Alan; Irving, Peter; Cummings, J R Fraser.
Citation:
Therapeutic Advances in Gastroenterology. 19:17562848261446551, 2026.
Abstract:
Background: VEST was a multi-centre study of real-world use of vedolizumab in inflammatory bowel disease (IBD) in routine practice in the United Kingdom.
Objectives: To describe real-world indications, effectiveness, patient-reported outcomes and safety.
Design: Prospective observational cohort study at 22 centres.
Methods: Patients receiving vedolizumab as part of standard care were included. Data were collected at infusion visits for activity indices (Harvey-Bradshaw Index (HBI) or partial Mayo Score (PMS)), physician global assessment (PGA), patient-reported quality-of-life and treatment perception (IBD-Control Questionnaire) and adverse events. Clinical response (Wk14) was defined as a reduction in HBI 3 or PMS 2, clinical remission as HBI 4 or PMS 1 and analysed using non-responder imputation. One-year persistence was defined as continuing on vedolizumab after an infusion at 48 weeks. Biomarker and endoscopic data were not available.
Results: 364 patients, mean age: 48 years; 132 (36%) with Crohn's disease (CD), 224 (62%) with UC and 8 (2%) with IBD-U; 174 (48%) male; 142 (39%) receiving steroids at baseline (Wk0); 141 (39%) bio-naive. At baseline, 279 (77%) had "active" disease. One-year persistence: 58% overall (54% for active disease). Among persistent cases (n = 212), median (IQR) IBD-Control-8 scores improved from 6 (3-10) at baseline to 14 (10-16) at post-induction (Wk14) and 1 year (p < 0.001 vs baseline). Corresponding scores for IBD-Control-VAS were: 50 (30-70), 80 (65-90) and 85 (70-95), respectively (p < 0.001 vs baseline). Each domain of IBD-Control-8 showed improvement. Baseline and post-induction health status (activity index, PGA or IBD-Control) were associated with 1-year persistence, but no significant associations were observed for disease type, duration, bio-naive status or baseline steroids. Of those with active disease at Wk0, clinical remission rates were 29%, 30% and 38% for CD, UC and IBD-U, respectively, and steroid-free remission rates were 26%, 27% and 38%. Similar remission rates were observed at 1 year. Possible adverse events leading to treatment cessation were rare (3%).
Conclusion: In routine clinical practice in the UK, vedolizumab demonstrated high levels of persistence. Similar rates of clinical response, remission and 1-year persistence were seen in UC and CD patients, and in bio-experienced versus naive cases. Persistent cases experienced significant and sustained improvements in quality of life and treatment perception. Persistence does not imply anti-inflammatory efficacy, as biomarker data were not available.
DOI: 10.1177/17562848261446551
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