Evaluation of the Optimal Position for Vedolizumab in the Japanese Treatment Paradigm for Ulcerative Colitis Using Markov Modeling

BackgroundThis analysis assessed the optimal position of vedolizumab for Japanese patients with ulcerative colitis.MethodsA Markov model was used to evaluate the performance of 4 treatment algorithms of vedolizumab position: after azathioprine (Algorithm 1); after tacrolimus/cytapheresis (Algorithm 2); after a first anti-tumor necrosis factor alpha (anti-TNFα) (Algorithm 3); and after a second anti-TNFα before colectomy (Algorithm 4).ResultsAlgorithm 1 was the dominant strategy, with an incremental benefit over the other algorithms of 0.028–0.031 quality-adjusted life years.ConclusionsThis simulation predicts that introducing vedolizumab immediately after a thiopurine and before other therapies will provide most benefit.Lay SummaryOur Markov simulation analysis predicts that introducing vedolizumab immediately after a thiopurine and before other therapies will provide the most benefit and should be considered for patients with steroid-dependent, moderate-to-severely active ulcerative colitis.