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Objective <p>Crohn’s disease (CD) frequently progresses to stricturing complications. Anti-stricture therapies are lacking, and anti-inflammatory therapies are hence the mainstay of medical treatment. However, data on the efficacy of vedolizumab in stricturing CD are not available. We therefore aimed to assess outcomes of vedolizumab in this setting.</p> Design/method <p>We evaluated adult patients who received vedolizumab within 6&#xa0;months of imaging-confirmed symptomatic ileal stricturing CD (CONSTRICT criteria) in a multicenter observational cohort study. Images were centrally read by an expert radiologist with experience in IBD imaging. Outcomes were rates of intervention (composite endpoint for endoscopic balloon dilation (EBD) <i>or</i> surgery during follow-up), EBD, surgery, obstructive symptoms, and vedolizumab persistence.</p> Results <p>Forty-four patients were included (61% female, median age 52&#xa0;years); 64% had an anastomotic stricture; 84% had received prior biologics. Median follow-up was 17&#xa0;months. Cumulative intervention rates were 23%, 44% and 50% of patients at 12, 24 and 48 months, respectively. 52% of patients reported symptom resolution, of whom 26% subsequently developed symptoms during follow-up. Vedolizumab persistence was 82%, 74% and 59% at 12, 24 and 48&#xa0;months. Anastomotic stricture was inversely associated with intervention (HR0.21, <i>P</i> = 0.012) and surgery (HR0.11, <i>P</i> = 0.013). Higher obstructive symptom index (HR4.47, <i>P</i> = 0.040) and degree of prestenotic bowel dilatation (HR1.09, <i>P</i> = 0.030) were associated with recurrent obstructive symptoms. Elevated baseline CRP was associated with vedolizumab discontinuation (HR1.96, <i>P</i> = 0.014).</p> Conclusion <p>Vedolizumab appears to be a treatment option in CD patients with terminal ileal strictures, especially in patients with anastomotic strictures, without obstructive symptoms or prestenotic bowel dilatation. Validation in prospective controlled studies is needed.</p>

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Vedolizumab for stricturing Crohn’s disease of the terminal ileum – an international multicenter cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月20日

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  • Sara El Ouali,
  • Mark E. Baker,
  • Cathy Lu,
  • Alexandra Medellin,
  • David H. Bruining,
  • Joel G. Fletcher,
  • Akitoshi Inoue,
  • Miguel Regueiro,
  • Ronald K. Ottichilo,
  • Shayla Schoenoff,
  • Ryan Rosentreter,
  • James Bena,
  • Taha Qazi,
  • Stefan D. Holubar,
  • Samantha Gauriloff,
  • Namita S. Gandhi,
  • Katherine Falloon,
  • Joseph Sleiman,
  • Benjamin L. Cohen,
  • Idan Goren,
  • Numan Balci,
  • Florian Rieder

摘要

Objective

Crohn’s disease (CD) frequently progresses to stricturing complications. Anti-stricture therapies are lacking, and anti-inflammatory therapies are hence the mainstay of medical treatment. However, data on the efficacy of vedolizumab in stricturing CD are not available. We therefore aimed to assess outcomes of vedolizumab in this setting.

Design/method

We evaluated adult patients who received vedolizumab within 6 months of imaging-confirmed symptomatic ileal stricturing CD (CONSTRICT criteria) in a multicenter observational cohort study. Images were centrally read by an expert radiologist with experience in IBD imaging. Outcomes were rates of intervention (composite endpoint for endoscopic balloon dilation (EBD) or surgery during follow-up), EBD, surgery, obstructive symptoms, and vedolizumab persistence.

Results

Forty-four patients were included (61% female, median age 52 years); 64% had an anastomotic stricture; 84% had received prior biologics. Median follow-up was 17 months. Cumulative intervention rates were 23%, 44% and 50% of patients at 12, 24 and 48 months, respectively. 52% of patients reported symptom resolution, of whom 26% subsequently developed symptoms during follow-up. Vedolizumab persistence was 82%, 74% and 59% at 12, 24 and 48 months. Anastomotic stricture was inversely associated with intervention (HR0.21, P = 0.012) and surgery (HR0.11, P = 0.013). Higher obstructive symptom index (HR4.47, P = 0.040) and degree of prestenotic bowel dilatation (HR1.09, P = 0.030) were associated with recurrent obstructive symptoms. Elevated baseline CRP was associated with vedolizumab discontinuation (HR1.96, P = 0.014).

Conclusion

Vedolizumab appears to be a treatment option in CD patients with terminal ileal strictures, especially in patients with anastomotic strictures, without obstructive symptoms or prestenotic bowel dilatation. Validation in prospective controlled studies is needed.