Higher rates of remission and healing with vedolizumab vs TNF antagonist

The effectiveness of vedolizumab to TNF antagonist therapy was assessed for both CD and UC patients, included in a multicentre consortium. Both studies found that vedolizumab-treated patients had higher rates of clinical remission, steroid-free remission, and endoscopic healing than TNF antagonist-treated patients [15,16].

These results were obtained after accounting for measurable disease- and patient-specific characteristics (which may affect biological effectiveness). Researchers performed a propensity score matching (1:1) accounting for age, sex, and prior disease-related hospitalisation within the previous year. Other factors matched were stricturing or penetrating disease complication history, prior bowel surgery, disease severity, steroid refractoriness or dependence, and prior TNF antagonist failure.

Treatment response was categorised using the Physician Global Assessment. Cumulative rates of clinical remission (complete resolution of disease-related symptoms) were compared. Steroid-free remission (on steroids at baseline, tapered off, not repeated for four weeks), and endoscopic healing (absence of ulcers or erosions) were also assessed.

The propensity score model accurately predicted the treatment status (AUC of 0.80 for CD; AUC of 0.73 for UC). From the initial 1,122 CD patients, 538 were included after matching (n=269 vedolizumab; 44% male; median age 35 years). Results were obtained after adjusting for concomitant steroid or IMM use, disease location (isolated small bowel, ileocolonic, isolated colonic), and prior TNF antagonists used. Vedolizumab-treated CD patients had numerically, but not statistically significantly higher 12-month cumulative rates for clinical (38% vs. 34%; HR 1.27) and steroid-free remission (26% vs. 18%; HR 1.75). They also had significantly higher 12-month cumulative rates for endoscopic healing (50% vs. 41%; HR 1.67). Among patients with colonic involvement, vedolizumab-treated patients had significantly higher rates of clinical remission, steroid-free remission, and endoscopic healing (see Table) [15].

Table: Vedolizumab vs. TNF antagonist therapy in CD [15]



Regarding UC, 334 of the initial 646 patients were included after matching (n=167 vedolizumab; 49% male; median age 36 years). Adjustments were made for concomitant steroid or IMM use, and the number of prior TNF antagonists used. Vedolizumab-treated UC patients had statistically significantly higher 12-month cumulative rates of clinical remission (54% vs. 37%; HR 1.54) and endoscopic healing (50% vs. 42%; HR 1.73). Cumulative 12-month rates for steroid-free remission were numerically higher for vedolizumab-treated patients, but not statistically significant (49% vs. 38%; HR 1.43). These findings were consistent when stratified by disease extent and prior TNF antagonist exposure [16].