UK Asians are prescribed vedolizumab earlier in disease history than Caucasians, but respond equally well to therapy

The phenotype and natural history of IBD in British Asians differs from Caucasians. As such response to treatment may also differ. UK Asians with CD at Royal London Hospital are more likely to stop anti TNFs due to treatment failure.1 This study investigates whether British and Caucasian patients also have a difference in response to Vedolizumab. A single-centre retrospective cohort study of patients prescribed Vedolizumab was undertaken. Cases were identified from attendance records of infusion clinics 2015–2017. Data collected included: ethnicity, Montreal Classification, disease duration until therapy, persistence on therapy and indication for cessation. Patients with ethnicity other than Asian and Caucasian were excluded. After screening 82 patients were identified, 47.6% (n = 39)CD, 50% (n = 41) UC and 2.4% (n = 2) IBD-U. Ethnicity was as follows: Asian (40.2%, n = 33) and Caucasian (59.8%, n = 49). Asian patients were younger at first infusion of Vedolizumab; median (IQR)age was 30 years (24–37.5) for Asians and 34 years (25.75–55.5)for Caucasians (p = 0.0272). The duration to follow-up did not vary with ethnicity for CD or UC: CD Asian 375 days (294.3–675.3), CD Caucasian 389 days (183–564) (p = 0.6874), UC Asian 428.5 days (233.8–609.8), Caucasian 494.5 days (141–745.5 days) (p = 0.8227). Montreal classification including perianal involvement did not vary with ethnicity. 76.8% (n = 63) of patients prescribed Vedolizumab had previously been prescribed a TNF antagonist. Prior anti TNF use also did not vary with ethnicity (p = 0.434). Asians with CD are prescribed Vedolizumab over 5 years earlier in disease course, as measured as duration of disease until first infusion; Asian 8.31 years (6.5–12.5) vs Caucasian 14.0 years (8.3–21.4) (p = 0.016). However disease duration at first prescription did not vary with UC; Asian 9.5 years (4.7–14.1) vs. Caucasian 9.6 years (3.6–14.8) (p = 0.789). Disease duration until Vedolizumab 46.3% patients prescribed Vedolizmab stopped therapy due to intolerance or suboptimal response. Rates of therapy failure did not differ with ethnicity (Asian 51.52% vs. Caucasian 40.82% p = 0.3727). Median persistence on Vedolizumab did not vary with ethnicity (CD Asian 152 days vs. Caucasian 183 days, p = 0.6947, UC Asian 218 days vs. Caucasian 162 days, p = 0.2791). Vedolizumab is prescribed earlier in disease course in British Asians with CD in comparison with Caucasians. However, persistence on Vedolizumab until treatment failure and rates of treatment failure did not differ between groups. 1. Gadhok et al. ECCO 2017: anti-TNFs more frequently stopped due to loss of response in British Asians with Crohn’s disease: a single-centre retrospective analysis. 2017.