P305 Indirect comparison of two novel biologics for the treatment of Crohn's disease : network-meta analysis of ustekinumab vs vedolizumab

Hather, Greg; Curtis, Rebecca; Minda, K.; Zouraq, Ismail Azzabi; Khalid, Javaria Mona

doi:10.1093/ecco-jcc/jjx002.430

Cited by 4 publications

(6 citation statements)

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“…Among the network meta‐analyses, two found no difference between ustekinumab and vedolizumab in induction 11,14 . Two meta analyses were limited to maintenance therapy, and found no statistical difference between vedolizumab and ustekinumab 12,13 . Taken together, these studies found a similar efficacy of vedolizumab and ustekinumab in induction.…”

Section: Discussionmentioning

confidence: 91%

“…Randomised placebo‐controlled trials have proven the efficacy of ustekinumab and of vedolizumab in anti‐TNF‐naïve and experienced CD patients, 9,10 but no head‐to‐head trial has compared these two drugs. Indirect comparisons and network meta‐analyses of randomised trials have led to conflicting conclusions 11‐17 . Recently, several observational studies have compared ustekinumab and vedolizumab, in patients with CD 18‐24 …”

Section: Introductionmentioning

confidence: 99%

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Systematic review with meta‐analysis: the effectiveness of either ustekinumab or vedolizumab in patients with Crohn's disease refractory to anti‐tumour necrosis factor

Parrot

Dong

Carbonnel

et al. 2021

Aliment Pharmacol Ther

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Summary Background Ustekinumab and vedolizumab are commonly used after anti‐tumour necrosis factor (TNF) failure in patients with Crohn’s disease (CD). No randomised controlled trial has compared these drugs. Aims To compare the effectiveness of ustekinumab and vedolizumab in CD patients refractory to anti‐TNF. Methods From PubMed, EMBASE and the Cochrane Library, through March 27, 2021, we identified studies that compared ustekinumab and vedolizumab in patients with CD refractory to anti‐TNF. The main outcomes were clinical remission and steroid‐free clinical remission at weeks 14 and 52. Secondary outcomes were biological remission and treatment persistence. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) using random effects meta‐analysis. Results We identified 1513 reports. Among them, 38 studies were assessed for eligibility and five studies were included. All studies included were of high quality: four were retrospective and one was prospective. Among 1026 patients, 659 received ustekinumab and 367 received vedolizumab. At week 14, clinical remission (OR 1.36; 95%CI: 0.74‐2.47; I2 = 50%), steroid‐free clinical remission (OR 1.24; 95%CI: 0.79‐1.92; I2 = 52%) and biological remission (OR 0.80; 95%CI: 0.50‐1.28; I2 = 0%) rates were similar between the two treatments. At week 52, ustekinumab was associated with higher rates of clinical remission (OR 1.87; 95% CI: 1.18‐2.98; I2 = 0%), steroid‐free clinical remission (OR 1.56; 95% CI: 1.23‐1.97; I2 = 0%), biological remission (OR 1.86; 95% CI: 1.03‐3.37; I2 = 29%) and treatment persistence (OR 2.37; 95% CI: 1.56‐3.62; I2 = 0%). Conclusion In patients with CD refractory to anti‐TNF, ustekinumab and vedolizumab are similarly effective in induction, but as maintenance treatment, ustekinumab appears to be more effective than vedolizumab.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: the effectiveness of either ustekinumab or vedolizumab in patients with Crohn's disease refractory to anti‐tumour necrosis factor

Parrot

Dong

Carbonnel

et al. 2021

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Clear evidence from direct head‐to‐head comparisons is currently lacking. Indirect comparisons by separate groups did not observe any significant difference between ustekinumab and vedolizumab in achieving clinical remission in anti‐TNF‐experienced CD . The efficacy of ustekinumab and vedolizumab in patients with fistulizing CD was reported in a recent meta‐analysis, with pooled RR 1.77 (95% CI, 0.93–3.37; P = 0.08) and RR 2.54 (95% CI, 0.63–10.29; P = 0.19), respectively .…”

Section: Choice Of Biologicsmentioning

confidence: 93%

“…Indirect comparisons by separate groups did not observe any significant difference between ustekinumab and vedolizumab in achieving clinical remission in anti-TNF-experienced CD. [70][71][72] The efficacy of ustekinumab and vedolizumab in patients with fistulizing CD was reported in a recent meta-analysis, with pooled RR 1.77 (95% CI, 0.93-3.37; P = 0.08) and RR 2.54 (95% CI, 0.63-10.29; P = 0.19), respectively. 73 Interestingly, while treatment response is known to be poorer in biologicexperienced patients, there may be a potential role of using the etiology of withdrawal to guide subsequent choices of biologic.…”

Section: Choice Of Biologicsmentioning

confidence: 96%

A review of vedolizumab and ustekinumab for the treatment of inflammatory bowel diseases

et al. 2018

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Recent advancement in the understanding of the pathophysiology of inflammatory bowel disease has seen an expansion in therapeutic options. Vedolizumab, a selective α4β7 inhibitor, and ustekinumab, an IL 12/23 p40 inhibitor, have provided the much‐awaited out‐of‐class alternatives for patients who have failed or who are intolerant to anti‐Tumor Necrosis Factor (TNF) therapy. However, questions remain as to how we may best use these novel therapeutic agents. We evaluate the evidence available from randomized controlled trials and postmarketing cohort studies and discuss their safety, efficacy, and limitations, in relation to anti‐TNF therapy, in optimizing the treatment outcomes.

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“…Therefore, in our study, patients were divided into first-line treatment and second-line treatment according to whether they had received anti-TNF agents before. In addition, most of previously published researches (7)(8)(9)(10)(11)(12)(13)(14) also focused on only biological agents, without considering the difference between the efficacy of traditional non-biological agents and biological agents. Some other researches (15,16) only described the efficacy of immunosuppressants and didn't include some new biological agents.…”

Section: Introductionmentioning

confidence: 99%

Will the Inducing and Maintaining Remission of Non-biological Agents and Biological Agents Differ for Crohn's Disease? The Evidence From the Network Meta-Analysis

et al. 2021

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Background: Several drugs currently are available for the treatment of Crohn's disease, including non-biological agents such as anti-inflammatory agents, steroids, immunosuppressive agents, and biologic agents such as anti-tumor necrosis factor (TNF), anti-α4β7 integrin, anti-alpha-4 integrin and anti-interleukin 12/23. However, the choice of treatments for induction and maintenance is still a challenge. The relevant comparison between non-biologic agents and biologic agents is few. In our research, we aimed to help making decisions, as well as providing clinicians and patients with medication references.Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of controlled trials for relevant randomized controlled trials published through to July 2020 and systematic reviews published from January 2011 to December 2020. Search results were screened by 2 independent reviewers first by title and abstract and then by full text. Disagreements were resolved through discussion with a third reviewer.Results: 54 randomized controlled trials were included in our analysis. For induction of remission, azathioprine (OR, 3.5; 95% Crl, 1.4–8.9), infliximab (OR, 4.1; 95% Crl, 1.2–16.0), infliximab + azathioprine (OR, 7.0; 95% Crl, 1.2–41.0) and infliximab+ methotrexate (OR, 7.8; 95% Crl, 1.2–65.0) were more effective in first-line therapy than placebo. Adalimumab showed superiority to placebo in second-line therapy, but the range of SD was wide. For maintenance of remission, adalimumab (OR,2.24;95% Crl,1.17–4.76) and azathioprine (OR,2.05; 95% Crl,1.14–3.96) were more effective than placebo. Adalimumab (OR,0.56; 95%Crl,0.27–1.2), budesonide (OR,0.63; 95%Crl,0.26–1.6) and natalizumab (OR,0.65; 95%Crl,0.30–1.4) was associated with less risk of withdrawals when compared with placebo.Conclusion: For induction of remission, azathioprine, infliximab, and infliximab + azathioprine were more effective in first-line therapy. In second-line therapy, adalimumab was more effective but should be interpreted carefully. For maintenance of remission, adalimumab and azathioprine were more effective. Besides, adalimumab, budesonide, natalizumab had lower withdrawals. Therefore, biological agents were not always better than non-biological agents and they have their own advantages in different treatment methods of Crohn's disease.

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P305 Indirect comparison of two novel biologics for the treatment of Crohn's disease : network-meta analysis of ustekinumab vs vedolizumab

Cited by 4 publications

References 0 publications

Systematic review with meta‐analysis: the effectiveness of either ustekinumab or vedolizumab in patients with Crohn's disease refractory to anti‐tumour necrosis factor

Systematic review with meta‐analysis: the effectiveness of either ustekinumab or vedolizumab in patients with Crohn's disease refractory to anti‐tumour necrosis factor

A review of vedolizumab and ustekinumab for the treatment of inflammatory bowel diseases

Will the Inducing and Maintaining Remission of Non-biological Agents and Biological Agents Differ for Crohn's Disease? The Evidence From the Network Meta-Analysis

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