The Effect Of Vitamin D Level On The Efficacy Of Vedolizumab And Ustekinumab In The Treatment Of Inflammatory Bowel Disease

Background:Vedolizumab and Ustekinumab are biological agents for the treatment of inflammatory bowel disease.However,only some patients are effective in the treatment of the two biological agents.Vitamin D,as a steroid hormone,has immunomodulatory effect.The level of vitamin D may affect the response of IBD patients to treatment with biological agents.The higher level of vitamin D before treatment in patients with IBD is related to the increased probability of initial response to anti-tumor necrosis factor treatment.Vitamin D can down-regulate the expression of α4β7 in peripheral blood and intestinal immune cells,inhibit IL-23 receptor pathway,and may have a synergistic effect with Vedolizumab and Ustekinumab biological agents.At present,the mechanism of treatment failure of the two biological agents is not clear.It is necessary to study and determine the changeable risk factors that predict the treatment response of Vedolizumab and Ustekinumab,in order to clarify the mechanism of treatment failure,improve the accuracy of treatment patients,and finally optimize the therapeutic effect of Vedolizumab and Ustekinumab in patients with IBD.Subjects and methods:A total of 85 patients with ulcerative colitis or Crohn’s disease diagnosed by the Department of Gastroenterology of the first Hospital of Jilin University from November2021 to December 2022 were treated with Vedolizumab or Ustekinumab.The clinical data were studied retrospectively.Results:1.The median vitamin D level in UC patients was 13.9 ng/ml.The median vitamin D level in patients with CD was 9.1 ng/ml.The average vitamin D level in patients with CD was lower than that in patients with UC.Patients with CD are more likely to suffer from severe vitamin D deficiency(P=0.048).2.After 14 weeks of treatment,the two biological agents significantly improved erythrocyte sedimentation rate,C-reactive protein,albumin,hemoglobin,vitamin D,Harvey-Bradshaw index or mayo score,simple endoscopic score for Crohn’s disease or mayo endoscopy score.3.In the 14 th week,54 patients responded(63.53%),including 30 cases of CD(62.5%)and 24 cases of UC(64.86%).53 patients with clinical remission accounted for 62.35%,including41 cases of CD(85.42%)and 3 cases of UC(6.25%).There were 26 cases of mucosal healing(30.59%),including 3 cases of CD(6.25%)and 23 cases of UC(62.16%).After14 weeks,the clinical remission rate of CD was significantly higher than that of UC(P< 0.01),and the mucosal healing rate of UC was significantly higher than that of CD(P< 0.01).The 14-week clinical remission rate of Ustekinumab was significantly higher than that of Vedolizumab(P < 0.01),and the mucosal healing rate of Vedolizumab was significantly higher than that of Ustekinumab(P < 0.01).4.There was a significant positive correlation between baseline vitamin D level and albumin level and 14-week clinical response rate.5.There was a significant correlation between baseline vitamin D level and clinical response rate at 14 weeks(P < 0.05).6.When the baseline vitamin D level was less than 12.5ng/ml,increasing the vitamin D level could significantly increase the clinical response rate of the two biological agents,while when the baseline vitamin D level was higher than 12.5ng/ml,the increase of vitamin D level had little effect on the clinical response rate.Conclusion:1.Vitamin D deficiency existed in all IBD patients.Vitamin D levels in CD patients were lower than those in UC patients.There was no significant difference in baseline vitamin D levels between the two biological agents.There was no significant correlation between baseline vitamin D levels and baseline disease severity.2.After 14 weeks of treatment,the two biological agents significantly decreased ESR,CRP,HBI or mayo scores,SES-CD or mayo endoscopic scores,and significantly increased the levels of albumin,hemoglobin and vitamin D.Most of these conclusions were established in the subgroup analysis.3.The 14-week clinical remission rate of Ustekinumab was significantly higher than that of Vedolizumab,and the mucosal healing rate of Vedolizumab was significantly higher than that of Ustekinumab.The 14-week clinical response rate of CD patients was higher than that of UC patients,and the mucosal healing rate of 14 weeks was higher than that of CD.There was no significant difference between the two biological agents in reducing ESR,CRP and increasing the levels of albumin,hemoglobin and vitamin D.These conclusions were also valid in the subgroup analysis.4.There was a significant correlation between baseline ESR,CRP,HBI or mayo scores,SES-CD or mayo endoscopic scores,albumin and hemoglobin,mainly weak and moderate correlation.The baseline vitamin D level was positively correlated with baseline albumin level and 14-week clinical response rate.The baseline albumin level and hemoglobin level were positively correlated with the 14-week clinical remission rate.5.There is a significant correlation between baseline vitamin D level and 14-week clinical response rate,and this association has a non-linear effect,which is still valid after removing confounding factors.6.When the baseline vitamin D level was less than 12.5ng/ml,the increase of vitamin D level had a great effect on the14-week clinical remission rate,while the baseline vitamin D level > 12.5ng/ml,the increase of baseline vitamin D level had little effect on the 14-week clinical response rate.