Five-year effectiveness of either ustekinumab or vedolizumab in 239 patients with Crohn's disease refractory to anti-tumour necrosis factor.

BACKGROUND

There are still conflicting data about superiority of ustekinumab over vedolizumab in patients with Crohn's disease (CD) who failed anti-tumour necrosis factor (anti-TNF).

AIM: To compare the 5-year effectiveness and safety of ustekinumab and vedolizumab in patients with CD who failed anti-TNF in a multicentre retrospective observational cohort.

METHODS

This is a retrospective cohort study including all consecutive patients with CD refractory or intolerant to anti-TNF who initiated either vedolizumab or ustekinumab between May 2014 and August 2018. Steroid-free clinical remission, clinical remission and treatment persistence were assessed at year 2, 3 and 5 with intention-to-treat analysis and propensity scores weighted logistic models.

RESULTS

A total of 239 patients were included, 107 received ustekinumab and 132 vedolizumab. At year 5, ustekinumab was associated with a higher rate of steroid-free clinical remission (41.2% vs 20.5%; odds ratio 2.72 [1.43-5.18]) and treatment persistence (46.8% vs 22.5%; OR 3.03 [1.63-5.63]) than vedolizumab but not the rate of CD-related intestinal surgery. Superiority of ustekinumab was more pronounced in patients with ileal CD, stricturing or penetrating behaviour, and history of intestinal CD-related surgery. Patients treated with ustekinumab, were associated with higher treatment persistence compared to patients treated with vedolizumab with low (p < 0.001) or intermediate (p < 0.001) but not with those with high vedolizumab CDST (p = 0.95).

CONCLUSION

In this study, ustekinumab was associated with higher rate of steroid-free clinical remission and treatment persistence than vedolizumab after 5 years of follow-up, particularly in patients with ileal CD, stricturing or penetrating behaviour and history of CD-related intestinal surgery.