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A GI's Perspective: Dr. Bincy Abraham

Dr. Bincy Abraham discusses how she considers patient preferences and clinical data when choosing Entyvio as an option for adults with moderately to severely active ulcerative colitis or Crohn's disease.

[Super]

The GI Perspective

[VO]

INDICATIONS: ENTYVIO (vedolizumab) is indicated in adults for the treatment of moderately to severely active UC or CD.

IMPORTANT SAFETY INFORMATION
ENTYVIO (vedolizumab) for injection is contraindicated in patients who have had a known serious or severe hypersensitivity reaction to ENTYVIO or any of its excipients. Please see additional Important Safety Information at the end of this video.

[Super]

INDICATIONS

Adult Ulcerative Colitis (UC)
ENTYVIO (vedolizumab) is indicated in adults for the treatment of moderately to severely active UC.

Adult Crohn's Disease (CD)
ENTYVIO (vedolizumab) is indicated in adults for the treatment of moderately to severely active CD.

IMPORTANT SAFETY INFORMATION ENTYVIO (vedolizumab) for injection is contraindicated in patients who have had a known serious or severe hypersensitivity reaction to ENTYVIO or any of its excipients.

Please see additional Important Safety Information at the end of this video.

[VO]

Hi. I am Dr. Bincy Abraham, Professor of Clinical Medicine in the Academic Division of Gastroenterology and Hepatology at Houston Methodist, Weill Cornell Medical College in Houston, Texas.

[Super]

Dr. Bincy Abraham

[VO]

Today I will answer some questions about Entyvio, a first-line advanced therapy for the treatment of adults with moderately to severely active ulcerative colitis or Crohn’s disease.

[Super]

Advanced therapies are therapies used after failure of conventional therapies.

[Super]

What are your considerations when selecting a first-line advanced therapy for moderately to severely active UC or CD?

CD=Crohn’s disease; UC=ulcerative colitis.

[VO]

Having so many treatment options is wonderful, but it becomes complex to figure out which one to use first. Since we don’t have many head-to-head trials, I consider patient characteristics, including disease severity and location, presence of complications, and comorbidities, including inflammatory conditions.

I also consider patient preference and lifestyle. Do they have a preference for oral, injectable, or infusion therapies? Do they have a busy life or frequently travel for work? Do they have any specific concerns about safety? Respecting patient preferences helps us choose a medication they will stick with. Lastly, access and affordability are very important. If patients cannot get on treatment, then it is difficult to move forward.

[Super]

What information do you rely on when deciding on a first-line advanced therapy in UC or CD?

[VO]

I rely on prominent data from clinical trials to inform a shared decision-making approach, especially if there are comparative data from head-to-head studies.

[Super]

"I rely on prominent data from clinical trials to inform a shared decision-making approach."

[VO]

Long-term data are important because patients will have their disease for the rest of their lives. They worry about safety, so these data help me reassure them and educate them on the risk and benefits of treatment versus not treating their disease.

National guidelines for ulcerative colitis and Crohn's disease are important, but I personalize therapy decisions based on my years of experience treating IBD.

[Super]

Which key clinical trials support the use of Entyvio for moderately to severely active UC and CD? What do you find most pertinent about them?

[VO]

The GEMINI I trial demonstrated that Entyvio can work quickly in moderately to severely active ulcerative colitis. GEMINI II and III were notable for the results at 1 year in moderately to severely active Crohn’s disease. VARSITY provided pertinent, comparative information about Entyvio and Humira in ulcerative colitis.

Safety results have been consistent. GEMINI long-term extension study showed consistent safety for up to 7 years, aligning with findings from the previous studies. All these trials support my decision to use Entyvio for my patients.

[Super]

"All these trials support my decision to use Entyvio for my patients."

[Super]

Can you describe an optimal UC patient type for Entyvio?

[VO]

This patient type would have moderately to severely active disease and, in my opinion, would ideally be biologic-naïve. Patients with a preference for infusion therapy are also good candidates.

[Super]

Can you describe an optimal CD patient type for Entyvio?

[VO]

In general, all patients with moderately to severely active Crohn's disease are eligible. Symptoms do not always track with endoscopic activity in Crohn's disease, so it's important to fully evaluate your Crohn’s disease patient for disease activity and the need for treatment.

[Super]

How would you describe the MOA of Entyvio to a colleague?

MOA=mechanism of action.

[VO]

For colleagues, I describe how, back in our medical school days, we learned about diapedesis of lymphocytes.

In ulcerative colitis and Crohn’s disease, specific memory T-lymphocytes access the inflamed gut tissue using this α4β7 integrin.

This integrin binds to MAdCAM-1 receptors on the endothelial cells in the gut, allowing these T-lymphocytes to squeeze through and get into the gut, causing inflammation.

Entyvio blocks the α4β7 integrin to prevent this process and helps address inflammation in the gut.

[Super]

Entyvio blocks lymphocyte interaction1

Entyvio specifically binds to the α4β7 integrin and blocks the interaction between the α4β7 integrin and MAdCAM-1, which is mainly expressed on GI tract endothelial cells.1-7

Inflammation is reduced1

T-lymphocyte migration into the gut is inhibited and inflammation is reduced.

References: 1. Entyvio (vedolizumab) prescribing information. Takeda Pharmaceuticals. 2. Briskin M, Winsor-Hines D, Shyjan A, et al. Am J Pathol. 1997;151(1):97-110. 3. Fedyk ER, Wyant T, Yang L-L, et al. Inflamm Bowel Dis. 2012;18(11):2107-2119. 4. Milch C, Wyant T, Xu J, et al. J Neuroimmunol. 2013;264(1-2):123-126. 5. Soler D, Chapman T, Yang L-L, Wyant T, Egan R, Fedyk ER. J Pharmacol Exp Ther. 2009;330(3):864-875. 6. Wyant T, Leach T, Sankoh S, et al. Gut. 2015;64(1):77-83. 7. Wyant T, Fedyk E, Abhyankar B. J Crohns Colitis. 2016;10(12):1437-1444.

[Super]

How would you describe the MOA of Entyvio to a patient? What attributes do they find notable?

[VO]

For patients, I explain that Entyvio works by preventing certain immune cells from going to the gut. Because Entyvio blocks these specific cells, it helps to control damaging inflammation in the GI tract. My patients find the gut-selective mechanism of action of Entyvio to be an attractive attribute. They love to hear that it acts directly in the gut, and when I explain how it works, they feel more comfortable with starting therapy and are engaged in their treatment for the long term.

[Super]

How do you sequence Entyvio in your treatment paradigm for UC and CD?

[VO]

Because of its safety and efficacy data, I think Entyvio is a good first-line advanced therapy option for my patients with moderately to severely active ulcerative colitis or Crohn's disease who are TNF-naÏve or have failed TNF antagonists.

[Super]

"I think Entyvio is a good first-line advanced therapy for my patients with moderately to severely active UC or CD."

[VO]

I base this on the published data and my own clinical experience with the safety and efficacy of Entyvio. Additionally, Entyvio is an agent that acts on inflammation directly in the gut. Discussing these attributes together with my patients helps us decide if Entyvio is right for them.