Preoperative Serum Vedolizumab Levels Do Not Impact Postoperative Outcomes in Inflammatory Bowel Disease
Authors: Parrish Aaron B. , Lopez Nicole E. , Truong Adam , Zaghiyan Karen , Melmed Gil Y. , McGovern Dermot P.B. , Ha Christina , Syal Gaurav , Bonthala Nirupama , Jain Anjali , Landers Carol J. , Targan Stephan R. , Fleshner Phillip 
Published: May 2021

BACKGROUND:
Vedolizumab has been proposed to lead to fewer postoperative complications because of its gut specificity. Studies, however, suggest an increased risk of surgical site infections, yet the data are conflicting.

OBJECTIVE:
This study aimed to assess the effect of vedolizumab drug levels on postoperative outcomes in patients undergoing major abdominal surgery for IBD.

DESIGN:
This was a retrospective study of a prospectively maintained database.

SETTING:
Patients were operated on by a single surgeon at an academic medical center.

PATIENTS:
A total of 72 patients with IBD undergoing major abdominal surgery were included.

INTERVENTIONS:
Patients were exposed preoperatively to vedolizumab.

MAIN OUTCOME MEASURES:
The primary outcome measured was the postoperative morbidity in patients who had IBD with detectable vs undetectable vedolizumab levels.

RESULTS:
A total of 72 patients were included in the study. Thirty-eight patients had detectable vedolizumab levels (>1.6 μg/mL), and 34 had undetectable vedolizumab levels. The overall rate of complications was 39%, and ileus was the most common complication. There were no significant differences in clinical variables between the detectable and undetectable vedolizumab level patient groups except for the time between the last dose and surgery (p < 0.01). There were 42 patients in the ulcerative colitis cohort; 48% had an undetectable vedolizumab level and 52% had a detectable vedolizumab level. There were no differences in any postoperative morbidity between ulcerative colitis groups. The Crohn’s cohort had 27 patients; 48% had an undetectable vedolizumab levels and 52% had a detectable vedolizumab level. There was a significantly lower incidence of postoperative ileus in patients who had Crohn’s disease with detectable vedolizumab levels compared with patients with an undetectable vedolizumab level (p < 0.04).

LIMITATIONS:
Limitations include a low overall patient population and a high rate of stoma formation.

CONCLUSIONS:
Serum vedolizumab levels do not influence postoperative morbidity in IBD. Vedolizumab may reduce the incidence of postoperative ileus in patients with Crohn’s disease. See Video Abstract at http://links.lww.com/DCR/B574.

LOS NIVELES DE VEDOLIZUMAB EN SUERO PREOPERATORIO, NO AFECTAN LOS RESULTADOS POSTOPERATORIOS EN LA ENFERMEDAD INFLAMATORIA INTESTINAL

ANTECEDENTES:

Se ha propuesto que el vedolizumab presenta menos complicaciones postoperatorias debido a su especificidad intestinal. Sin embargo, estudios sugieren un mayor riesgo de infecciones en el sitio quirúrgico, aunque los datos son contradictorios.

OBJETIVO:

Evaluar el efecto en los niveles del fármaco vedolizumab, en resultados postoperatorios de pacientes sometidos a cirugía mayor abdominal, por enfermedad inflamatoria intestinal.

DISEÑO:

Estudio retrospectivo de una base de datos mantenida prospectivamente.

ENTORNO CLÍNICO:

Pacientes intervenidos por un solo cirujano en un centro médico académico.

PACIENTES:

Un total de 72 pacientes con enfermedad inflamatoria intestinal sometidos a cirugía mayor abdominal.

INTERVENCIONES:

Exposición preoperatoria a vedolizumab.

PRINCIPALES MEDIDAS DE VALORACIÓN:

Morbilidad postoperatoria en pacientes con enfermedad inflamatoria intestinal, con niveles detectables versus no detectables de vedolizumab.

RESULTADOS:

Se incluyó en el estudio a un total de 72 pacientes. Treinta y ocho pacientes tuvieron niveles detectables de vedolizumab (> 1,6 mcg / ml) y 34 con niveles no detectables de vedolizumab. La tasa global de complicaciones fue del 39% y el íleo fue la complicación más común. No hubo diferencias significativas en las variables clínicas entre los grupos de pacientes con niveles detectables y no detectables de vedolizumab, excepto por el intervalo de tiempo entre la última dosis y la cirugía (p <.01). La cohorte de colitis ulcerosa tuvo 42 pacientes, el 48% con un nivel no detectable de vedolizumab y el 52% un nivel detectable de vedolizumab. No hubo diferencias en ninguna morbilidad postoperatoria entre los grupos de colitis ulcerosa. La cohorte de Crohn tuvo 27 pacientes, 48% con niveles no detectables de vedolizumab y el 52% con niveles detectables de vedolizumab. Hubo una incidencia significativamente menor de íleo postoperatorio en pacientes de Crohn con niveles detectables de vedolizumab, comparados con los pacientes con un nivel no detectable de vedolizumab (p <0,04).

LIMITACIONES:

Las limitaciones incluyen una baja población general de pacientes y una alta tasa de formación de estomas.

CONCLUSIONES:

Los niveles séricos de vedolizumab no influyen en la morbilidad postoperatoria de la enfermedad inflamatoria intestinal. Vedolizumab puede reducir la incidencia de íleo postoperatorio en pacientes de Crohn. Consulte Video Resumen en http://links.lww.com/DCR/B574.