Compared with vedolizumab monotherapy, combination therapy with vedolizumab and thiopurines was associated with lower treatment failure in patients with Crohn disease (CD) but not ulcerative colitis (UC), according to a study published in Gut.

For the observational study, researchers searched US health care claims databases — IBM MarketScan (MarketScan) 2009-2018 and Optum’s deidentified Clinformatics Data Mart Database (Optum) 2009-2020 — to identify adults aged 18 years and older with 1 or more visits for CD and UC. Patients with CD (n=4674) and patients with UC (n=5625) were treated with combination therapy (18.2% of patients with CD and 16.8% of patients with UC) or vedolizumab monotherapy (89.8% of patients with CD and 93.2% of patients with UC).

After 1:1 propensity score (PS) matching, treatment failure occurred at week 26 in 236 (29.3%) and 376 (34.3%) patients with CD initiating combination therapy and vedolizumab monotherapy, respectively. In patients with UC initiating combination therapy or vedolizumab monotherapy, 236 (21.7%) and 263 (24.2%), respectively, experienced treatment failure at week 16. Serious infection and hospitalization rates not related to inflammatory bowel disease (IBD) did not differ between the 2 treatment groups.


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Study limitations included not being able to exclude individuals who used thiopurines in the combination therapy group.

“This study based on [3] large population-based cohorts of patients with IBD in both the USA and France provides evidence that combination therapy with vedolizumab and thiopurines is more effective compared with vedolizumab monotherapy in patients with CD and possibly less so with UC,” the researchers concluded. “These findings will help guide clinical decision-making in patients with IBD starting vedolizumab.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Kirchgesner J, Desai RJ, Schneeweiss MC, Beaugerie L, Schneeweiss S, Kim SC. Decreased risk of treatment failure with vedolizumab and thiopurines combined compared with vedolizumab monotherapy in Crohn’s disease. Gut. Published online April 6, 2022. doi:10.1136/gutjnl-2022-327002