VIVID-2: Mirikizumab Remains Effective Through 2 Years—and Some Late Nonresponders Can Be Rescued: CGH | September 2026

Introduction:

Long-term durability and management of incomplete response are important when positioning IL-23 therapy in Crohn’s disease. VIVID-2 evaluated mirikizumab through 104 weeks, including IV reinduction in patients without endoscopic response at one year.

Why was this study needed?

Long-term endoscopic durability with mirikizumab needed confirmation.

The optimal approach to patients missing endoscopic targets at one year remains uncertain.

Reinduction may offer an alternative to immediately switching therapy.

Key Findings:

430 patients were evaluated through 104 weeks.

At week 104, 60.5% achieved endoscopic response and 37.9% endoscopic remission.

CDAI remission reached 73.4%.

Among week-52 endoscopic responders, 81.8% maintained response.

Endoscopic remission was maintained in 72.5% of previous responders.

Importantly, 30.9% of week-52 endoscopic nonresponders subsequently responded after IV reinduction followed by continued SC therapy.

The rescue strategy is promising but requires confirmation because VIVID-2 was an open-label extension without a comparator.

Bottom Line:

Mirikizumab showed durable 2-year efficacy in Crohn’s disease. Importantly, selected one-year endoscopic nonresponders may still respond after reinduction, suggesting that missing an endoscopic target does not always mandate an immediate switch.