Vedolizumab versus ustekinumab

In 2 comparative studies, ustekinumab was found to be more effective than vedolizumab in patients with Crohn’s disease (CD) refractory to anti-TNF. Safety outcomes were comparable.

A French head-to-head study included 239 patients, of whom 107 received ustekinumab and 132 vedolizumab [1]. After propensity scoring, there was no difference between the groups. After 48 weeks, the clinical remission rate was higher in the ustekinumab versus the vedolizumab group (54.4% vs 38.3%; OR 1.92; 95% CI 1.09–3.39). Other results after 48 weeks:

• Corticosteroid-free remission was numerically higher in the ustekinumab group (44.7% vs 34.0%; OR 1.57; 95% CI 0.88–2.79).
• Treatment persistence was significantly more frequent in the ustekinumab group (71.5% vs 49.7%; OR 2.54; 95% CI 1.40–4.62).
• The dose optimisation rate at week 48 was higher with vedolizumab (53.5% vs 30.1%; OR 0.37; 95% CI 0.21–0.67).
• Ustekinumab was associated with higher clinical remission rates in patients with ileal CD (OR 3.49; 95% CI 1.33–9.17), penetrating disease (OR 6.58; 95% CI 1.91–22.68) and a history of perianal disease (OR 2.48; 95% CI 1.04–5.93).
• Regardless of treatment group, combination therapy was associated with a higher clinical remission rate (OR 1.93; 95% CI 1.09–3.43).

In a comparable Dutch study, ustekinumab was also associated with higher efficacy than vedolizumab [2]. In a prospective registry specifically developed for comparative studies, a total of 128 vedolizumab- and 85 ustekinumab-treated patients fulfilled inclusion criteria, of which 69 patients in each group were then matched. The ustekinumab group was more likely to achieve corticosteroid-free clinical remission (OR 2.56; 95% CI 1.35–4.87; P=0.004), biochemical remission (OR 2.22; 95% CI 1.04–4.74; P=0.040), and combined corticosteroid-free clinical and biochemical remission (OR 2.58; 95% CI 1.15–5.78; P=0.022).

1. 
   
   1. Alric H, et al. ECCO-IBD 2020, DOP80.
   2. Biemans V, et al. ECCO-IBD 2020, DOP77.

 



Posted on 14 April 202018 March 2021