BMC Gastroenterol. 2022 Jun 8;22(1):291.doi: 10.1186/s12876-022-02347-1.

Laurent Peyrin-Biroulet ¹, Perttu Arkkila ², Alessandro Armuzzi ³, Silvio Danese ⁴, Jordi Guardiola ⁵, Jørgen Jahnsen ⁶, Charles Lees ⁷, Edouard Louis ⁸, Milan Lukáš ⁹, Walter Reinisch ¹⁰, Xavier Roblin ¹¹, Minyoung Jang ¹², Han Geul Byun ¹², Dong-Hyeon Kim ¹², Sung Jeong Lee ¹², Raja Atreya ¹³

Author information

¹Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.

²Department of Gastroenterology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

³Humanitas Research Hospital, Milan, Rozzano, Italy.

⁴Gastroenterology and Endoscopy, University Vita-Salute San Raffaele, Milan, Italy.

⁵Digestive Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

⁶Department of Gastroenterology, Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway.

⁷Center of Genomics and Experimental Medicine, University of Edinburgh, Edinburgh, UK.

⁸Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium.

⁹ISCARE Clinical Centre, Prague, Czech Republic.

¹⁰Medical University of Vienna, Vienna, Austria.

¹¹University Hospital of Saint-Etienne, Saint-Etienne, France.

¹²Celltrion Healthcare, Incheon, Republic of Korea.

¹³Medical Department 1, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany. raja.atreya@uk-erlangen.de.

Abstract

Background and aims: There are limited comparative data for infliximab and vedolizumab in inflammatory bowel disease patients.

Methods: We conducted a systematic review and meta-analysis to compare the efficacy and safety of infliximab and vedolizumab in adult patients with moderate-to-severe Crohn's disease or ulcerative colitis.

Results: We identified six eligible Crohn's disease and seven eligible ulcerative colitis trials that randomised over 1900 participants per disease cohort to infliximab or vedolizumab. In the Crohn's disease and ulcerative colitis cohorts, infliximab yielded better efficacy than vedolizumab for all analysed outcomes (CDAI-70, CDAI-100 responses, and clinical remission for Crohn's disease and clinical response and clinical remission for ulcerative colitis) during the induction phase, with non-overlapping 95% confidence intervals. In the maintenance phase, similar proportions of infliximab- or vedolizumab-treated patients achieved clinical response, clinical remission, or mucosal healing in both Crohn's disease and ulcerative colitis. For the safety outcomes, rates of adverse events, serious adverse events, and discontinuations due to adverse events were similar in infliximab- and vedolizumab-treated patients in both diseases. The infection rate was higher in infliximab for Crohn's disease and higher in vedolizumab when treating patients with ulcerative colitis. There was no difference between the treatments in the proportions of patients who reported serious infections in both indications.

Conclusions: Indirect comparison of infliximab and vedolizumab trials in adult patients with moderate-to severe Crohn's disease or ulcerative colitis demonstrated that infliximab has better efficacy in the induction phase and comparable efficacy during the maintenance phase and overall safety profile compared to vedolizumab.