William Sandborn, MD: Updates From ACG 2019

Ustekinumab, tofacitinib, and vedolizumab are 3 of the featured drugs presented on several different studies at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019) in San Antonio, Texas.

William Sandborn, MD, chief of the division of gastroenterology at University of California, San Diego, explained in an interview with MD Magazine® some of the crucial studies presented during the meeting.

MD Magazine: What have been the highlights of ACG 2019 for you?

Sandborn: I think this conference is sort of an evolutionary year. We see the introduction of ustekinumab into clinical practice for ulcerative colitis. So that's a kind of a landmark thing.

We have been watching subcutaneous vedolizumab, which I anticipate will be approved sometime in the early part of next year. So switching from intravenous induction to subcutaneous maintenance of that vedolizumab is very interesting.

Earlier this year, the VARSITY trial was published comparing adalimumab versus vedolizumab for patients with ulcerative colitis.

And at this meeting, we saw some data about histology for that outcome measures well, so once again, seeing that it's possible to get not only endoscopic remission histologic remission for patients with ulcerative colitis. And that looked to be a bit more robust with vedolizumab.

There'll be a presentation tomorrow looking at the deep vein thrombosis and pulmonary embolism rates and patients with ulcerative colitis treated with tofacitinib.

And what we saw was during the placebo controlled portion of that trial, that all of the DVTs and PEs occurred in patients who were receiving placebo not tofacitinib.

Then when you got into the long-term extension, you could see some incident some cases of DVT and PE, but at a lower rate than what was observed in a recent trial with older patients with rheumatoid arthritis who had cardiovascular risk factors.

So I think given the recent FDA labeling changes for tofacitinib for ulcerative colitis, we've been thoughtful and cautious about how to use it. But these data do suggest that the DVT and PE risk in patients with inflammatory bowel disease and ulcerative colitis specifically, may not be as high as in that high risk rheumatoid arthritis population.