Efficacy and Safety of Infliximab and Vedolizumab Maintenance Therapy in Patients with Crohn's Disease and Ulcerative Colitis: A Systematic Review and Meta-Analysis.

Background/

Objectives

Direct comparative data for infliximab and vedolizumab are limited due to lack of head-to-head trials. This systematic review and meta-analysis compared the efficacy and safety of infliximab and vedolizumab as intravenous or subcutaneous maintenance treatments for adults with moderately to severely active Crohn's disease or ulcerative colitis.

Methods

Medical databases, PubMed, Embase, and the Cochrane Library were systematically searched from January 2010 to May 2024 to identify Phase 1 to 3 randomized controlled trials. The primary and co-primary outcomes were the proportions of patients achieving clinical remission and clinical response at one year, respectively. Safety was also analyzed (PROSPERO CRD42023483599). Data for each outcome were pooled using a two-sided random-effects model in separate analyses for Crohn's disease and ulcerative colitis.

Results

Seven eligible Crohn's disease trials and eight eligible ulcerative colitis trials contributed data for 1910 and 2372 patients, respectively. For Crohn's disease, higher proportions of infliximab-treated patients achieved clinical remission (0.64 [95% confidence interval: 0.60-0.68]) and/or clinical response (0.71 [0.67-0.75]) at one year compared with vedolizumab-treated patients (0.40 [0.35-0.46] and 0.47 [0.43-0.51], respectively). For ulcerative colitis, similar proportions of infliximab- and vedolizumab-treated patients achieved clinical remission (0.54 [0.38-0.71] vs. 0.40 [0.35-0.44]) and/or clinical response (0.52 [0.45-0.58] vs. 0.58 [0.51-0.65]) at one year. Safety results showed no significant differences.

Conclusions

An indirect comparison of maintenance treatment with infliximab and vedolizumab demonstrated that infliximab yields significantly better efficacy than vedolizumab in Crohn's disease, whereas both agents yielded similar efficacy in ulcerative colitis.