Patients with refractory ulcerative colitis (UC) were more likely to achieve clinical remission with vedolizumab (VDZ) than with infliximab (IFX), according to the results of a study published in Alimentary Pharmacology & Therapeutics.
Hupé and colleagues conducted a retrospective review to compare the efficacy of IFX and VDZ in patients with UC that failed to respond to initial treatment with an anti-tumor necrosis factor (TNF) agent.
Data were collected from 12 French centers that had patients with UC who started treatment with IFX or VDZ after at least 1 injection of anti-TNF therapy (adalimumab or golimumab). Outcomes were clinical remission at week 14, long-term outcomes, and safety and survival (without treatment discontinuation and without UC-related events).
Overall, 225 patients (59% men, 41% women; mean age [±SD] 42.7±16.7 years) with a mean disease duration of 86.9 (±94.7) months were included in the study; of those, 154 (68%) received IFX and 71 (32%) received VDZ.
At week 14, more patients in the VDZ group (35/71, 49%) achieved clinical remission compared with those in the IFX group (40/154, 26%; P = .001), and this difference remained significant after propensity score matching analysis (odds ratio, 1.67; 95% CI, 1.08-2.56; P = .02).
At median follow-up of 117 weeks, survival rates without treatment discontinuation at 1 year were 50% and 80% with IFX and VDZ, respectively; at 3 years, survival rates were 29% and 55% with IFX and VDZ, respectively (P <.001).
Survival rates without UC-related events were 49% and 74% with IFX and VDZ, respectively, at 1 year and 27% and 52% with IFX and VDZ, respectively, at 3 years (P <.01).
“After failure of a first subcutaneous anti-TNF agent, UC patients were more likely to achieve clinical remission with VDZ than those treated with IFX,” wrote the authors. “Although due to prescription habits patients in the IFX group had a significantly more severe disease, these differences remained after adjustments and subgroup analyses. Such results have to be confirmed prospectively and warrant dedicated head-to-head trials.”
Hupé M, Rivière P, Nancey S, et al. Compared efficacy and safety of vedolizumab and infliximab in ulcerative colitis after failure of a first subcutaneous anti-TNF agent: a multicentre cohort study [published online March 22, 2020]. Aliment Pharmacol Ther. doi:10.1111/apt.15680