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

Abstract

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.

An Objective Comparison of Vedolizumab and Ustekinumab Effectiveness in Crohn's Disease Patients' Failure to TNF-Alpha Inhibitors

“…No differences were reported at week 24, whereas at week 52, a small but significant difference (∆ 10%) was found in favor of UST. A recent meta-analysis including the aforementioned studies favored UST over VDZ in the induction of SFR at week 52 but not at week 14 (15).…”

Vedolizumab more likely to be discontinued than ustekinumab in anti-TNF-experienced patients with fistulizing Crohn’s disease

“…Indeed, prospective registry data and retrospective observational data have shown that in individuals with CD are more likely to achieve and remain in remission on UST, 16 , 17 and a recent meta-analysis shows that UST is more effective than VDZ for maintenance in people with anti-TNF-refractory CD. 18 …”

Ustekinumab is associated with superior treatment persistence but not with higher remission ratesversusvedolizumab in patients with refractory Crohn’s disease: results from a multicentre cohort study

“… 25 A meta-analysis that compared the efficacies of UST and VDZ in CD also collected data about clinical SFR and treatment persistence and found significant superiority of UST in both clinical SFR at week 52 and in drug persistence. 26 A recent multicentre-retrospective study from Italy displayed the equality of UST and VDZ in terms of achieving objective remission among patients with anti-TNF refractory CD at week 52; however, clinical remission rates differed. 27 Our study found 1-year persistence rates of 86.5% for UST and 57.9% for VDZ treatment, which are higher than the rates found by Ylisaukko-Oja et al of 46.2%–37.1% for ADA and 47.1% for UST during 12 months of treatment in a real-life setting.…”