Combining Anti-TNF-α and Vedolizumab in the Treatment of Inflammatory Bowel Disease: A Case Series

Background: Anti-tumor necrosis factor alpha (anti-TNF-alpha) is important in the treatment of inflammatory bowel disease, but some patients experience only a partial response. In these patients, a combination of anti-TNF-alpha and vedolizumab (VDZ) may act as a bridge until the full VDZ effect occurs. At present, clinical data on combination treatment with anti-TNF-alpha and VDZ are not available. The aim of this case series was to evaluate the safety and clinical response of combination therapy with anti-TNF-alpha and VDZ in clinical practice. Methods: All patients started on combination treatment with anti-TNF-alpha and VDZ from November 2015 to July 2016 were prospectively followed for at least 12 months. Results: Six patients with ulcerative colitis and four patients with Crohn's disease received combination treatment. These patients were followed for a median of 1712-20 months. No more adverse events than expected with anti-TNF-alpha alone were observed during combination treatment. At the end of follow-up, all patients were in clinical remission, and 8 patients could discontinue anti-TNF-alpha treatment and receive VDZ monotherapy. Two of the patients with Crohn's disease required combination treatment throughout follow-up to obtain sustained remission. Conclusion: Our findings suggest that combination treatment with anti TNF-alpha and VDZ is safe and might represent a long-term treatment option in selected patients.