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Comparative Study of the Effectiveness of Vedolizumab Versus Ustekinumab After Anti-TNF Failure in Crohn's Disease (Versus-CD): Data from the ENEIDA Registry.

Publicado en:Journal Of Crohns & Colitis. 18 (1): 65-74 - 2024-01-27 18(1), DOI: 10.1093/ecco-jcc/jjad124

Autores: García MJ; Rivero M; Fernández-Clotet A; de Francisco R; Sicilia B; Mesonero F; de Castro ML; Casanova MJ; Bertoletti F; García-Alonso FJ; López-García A; Vicente R; Calvet X; Barreiro-de Acosta M; Ferrer Rosique J; Varela Trastoy P; Nuñez A; Ricart E; Riestra S; Arias García L; Rodríguez M; Arranz L; Pajares R; Mena R; Calafat M; Camo P; Bermejo F; Ponferrada Á; Madrigal RE; Llaó J; Sesé E; Sánchez E; Pineda Mariño JR; González Muñoza C; Carbajo López AY; Julián AB; Villoria Ferrer A; Baston-Rey I; Jara L; Almela P; Codesido L; de la Maza S; Leal C; Caballol B; Pérez-Martínez I; Vinuesa Campo R; Crespo J; Domènech E; Chaparro M; Gisbert JP

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Resumen

Both vedolizumab and ustekinumab are approved for the management of Crohn's disease [CD]. Data on which one would be the most beneficial option when anti-tumour necrosis factor [anti-TNF] agents fail are limited. To compare the durability, effectiveness, and safety of vedolizumab and ustekinumab after anti-TNF failure or intolerance in CD. CD patients from the ENEIDA registry who received vedolizumab or ustekinumab after anti-TNF failure or intolerance were included. Durability and effectiveness were evaluated in both the short and the long term. Effectiveness was defined according to the Harvey-Bradshaw index [HBI]. The safety profile was compared between the two treatments. The propensity score was calculated by the inverse probability weighting method to balance confounder factors. A total of 835 patients from 30 centres were included, 207 treated with vedolizumab and 628 with ustekinumab. Dose intensification was performed in 295 patients. Vedolizumab [vs ustekinumab] was associated with a higher risk of treatment discontinuation (hazard ratio [HR] 2.55, 95% confidence interval [CI]: 2.02-3.21), adjusted by corticosteroids at baseline [HR 1.27; 95% CI: 1.00-1.62], moderate-severe activity in HBI [HR 1.79; 95% CI: 1.20-2.48], and high levels of C-reactive protein at baseline [HR 1.06; 95% CI: 1.02-1.10]. The inverse probability weighting method confirmed these results. Clinical response, remission, and corticosteroid-free clinical remission were higher with ustekinumab than with vedolizumab. Both drugs had a low risk of adverse events with no differences between them. In CD patients who have failed anti-TNF agents, ustekinumab seems to be superior to vedolizumab in terms of durability and effectiveness in clinical practice. The safety profile is good and similar for both treatments.

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