Confocal laser endomicroscopy as predictive biomarker of clinical and endoscopic efficacy of vedolizumab in ulcerative colitis: The DETECT study

Aims In patients with ulcerative colitis (UC), no biomarker is available to help the physician to choose the most suitable biotherapy. The primary objective of this pilot study was to assess the feasibility of identification of alpha 4 beta 7- and TNF-expressing cells, to predict the response to vedolizumab using confocal laser endoscopy (CLE).Methods Patients with moderate-to-severe UC, naive of biotherapy, received vedolizumab. Clinical evaluation was performed at each infusion. Endoscopic evaluation was performed before inclusion and at week 22. Fresh colonic biopsies were stained using FITC-labelled vedolizumab and Alexa fluor-labelled adalimumab and ex vivo dual-band CLE images were acquired. Blood samples were collected to measure trough concentrations of vedolizumab and to determine absolute counts of T and B cells subpopulations, NK cells and monocytes.Results Nineteen patients were enrolled in the study and received at least one dose of vedolizumab. Clinical remission and endoscopic improvement were observed in 58% of whom 5 patients (45%) had an endoscopic subscore of 0. In terms of clinical response and remission, endoscopic improvement and histologic response, FITC-conjugated vedolizumab staining tended to be higher in responder patients compared to non-responders at week 22. A threshold value of 6 positive FITC-vedolizumab staining areas detected by CLE seemed informative to discriminate the responders and non-responders. The results were similar in terms of clinical remission and endoscopic improvement with a sensitivity of 78% and a specificity of 85% (p = 0.05). Trough concentrations and blood immune cells were not associated with responses to vedolizumab.Conclusion This pilot study demonstrate that dual-band CLE is feasible to detect alpha 4 beta 7- and TNF-expressing cells. Positive alpha 4 beta 7 staining seems to be associated with clinical and endoscopic remission in UC patients treated by anti-alpha 4 beta 7-integrin, subject to validation by larger-scale studies. Clinical-trial.gov: NCT02878083Conclusion This pilot study demonstrate that dual-band CLE is feasible to detect alpha 4 beta 7- and TNF-expressing cells. Positive alpha 4 beta 7 staining seems to be associated with clinical and endoscopic remission in UC patients treated by anti-alpha 4 beta 7-integrin, subject to validation by larger-scale studies. Clinical-trial.gov: NCT02878083