Effectiveness of vedolizumab to reduce bowel urgency in a Canadian real-world inflammatory bowel disease cohort.

Background and Aims: Bowel urgency is a burdensome symptom of inflammatory bowel disease (IBD) that greatly impacts quality of life. This study evaluated vedolizumab effectiveness on bowel urgency in Canadian patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Adults with moderately to severely active UC or CD with baseline Urgency Numeric Rating Scale (UNRS) scores enrolled in the Canadian Patient Support Program (July 2024-March 2025) were included. Bowel urgency and clinical endpoints were evaluated at 2, 6, and 14 weeks. Clinically meaningful improvement (CMI) was defined as UNRS change from baseline ≥3 among patients with baseline UNRS ≥3. UC clinical remission was defined as pM (partial Mayo) score <3. CD clinical response was defined as Harvey-Bradshaw Index (HBI) decrease ≥3 and ≥25% from baseline; remission as HBI <5. Results: Of 412 vedolizumab-treated patients (319 UC, 93 CD), most were bio-naïve (UC: 89%, CD: 63%) with median disease durations of 4 years (UC) and 7 years (CD). At baseline, 268 (84%) UC and 74 (80%) CD patients had UNRS ≥3. Median time to CMI was 6 weeks in both cohorts. By week 14, UC patients experienced a 5-point median UNRS reduction (80%) and CD patients a 4-point reduction (62%). Patients achieving CMI at weeks 6 and 14 were significantly more likely to achieve clinical remission. Week 2 urgency outcomes were significant predictors of later outcomes. Conclusions: Most UC and CD patients achieved CMI by 6 weeks. CMI was significantly associated with validated clinical outcomes, demonstrating real-world effectiveness of vedolizumab in reducing bowel urgency.