Early decline in anti-integrin αvβ6 autoantibodies strongly predicts 1-year clinical remission in vedolizumab-treated patients with ulcerative colitis
Year: 2026
Type: article
Abstract: Background: Anti-integrin αvβ6 immunoglobulin G autoantibodies have emerged as one of the most accurate non-invasive biomarkers for ulcerative colitis (UC). We aimed to validate their diagnostic performance in a French multicentre cohort of patients with inflammatory bowel disease (IBD) and to evaluate their predictive value for vedolizumab clinical response. Methods: We performed a multicentre, non-interventional post hoc analysis using prospectively collected serum samples and clinical data from two parent prospective observational studies: VEDOPREDIRESP (patients with IBD initiating vedolizumab) and GOLILOR (patients with UC undergoing golimumab dose intensification). Serum anti-αvβ6 autoantibody titres were quantified by ELISA at baseline and week 6 (VEDOPREDIRESP) or week 8 (GOLILOR), blinded to clinical outcomes. The primary endpoint was sustained clinical remission at week 52. Results: In the VEDOPREDIRESP cohort (n=115; 67 UC, 48 Crohn's disease (CD), sustained clinical remission at week 52 was achieved in 54% of patients with UC. Baseline serum anti-αvβ6 autoantibody titres were significantly higher in UC than in CD (median 271 ng/mL (IQR 38-884) vs 5.2 ng/mL (2.5-10), p<0.001), with seropositivity (>9.1 ng/mL) in 94% vs 19%, respectively. Receiver operating characteristic (ROC) analysis confirmed excellent diagnostic performance to discriminate between UC and CD (area under the ROC curve (AUC) 0.93; optimal cut-off 15 ng/mL; sensitivity 92%, specificity 95%). In patients with UC treated with vedolizumab, titres declined significantly from baseline to week 6 (median 243 ng/mL (176-884) to 190 ng/mL (89-320), p=0.040). A >30% reduction at week 6 strongly predicted sustained remission at week 52 (AUC 0.79; sensitivity 78%, specificity 80%). Multivariable analysis identified this early decline as the only statistically significant independent predictor of 1-year remission (adjusted OR 5.36, 95% CI 1.12 to 8.54, p=0.040). Notably, in an independent cohort of 47 patients with UC undergoing golimumab dose intensification, there was no reduction in median serum anti-αvβ6 autoantibody levels, with levels remaining stable from 197 ng/mL at week 0 to 205 ng/mL (97-457) at week 8 (p=0.730). Conclusions: Anti-αvβ6 autoantibodies robustly discriminate UC from CD. In patients with UC treated with vedolizumab, their early and selective decline predicts clinical remission at 1 year and provides a precision tool to optimise gut-selective therapy in real time.
Source: eGastroenterology
Institutions: Lyon 1 Université, École Normale Supérieure de Lyon, Centre National de la Recherche Scientifique, Inserm, Centre Hospitalier Universitaire de Saint-Étienne, Centre International de Recherche en Infectiologie, Université Jean Monnet, Université Jean Monnet, Centre Hospitalier Universitaire Amiens-Picardie, Hôpital Lyon Sud, Centre Hospitalier Universitaire de Nice, Centre de recherche en Epidémiologie et Santé des Populations, Bicêtre Hospital, Centre Hospitalier Universitaire de Montpellier, Monash University, Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225090140