Abstract

Long-Term Outcomes of an Infliximab-First Versus Vedolizumab-First Treatment Strategy in Biologic-Naïve Patients With Ulcerative Colitis

Aliment Pharmacol Ther. 2025 Feb;61(4):693-701.doi: 10.1111/apt.18441. Epub 2024 Dec 11.

Austin Haynesworth 1Kuan-Hung Yeh 2Han Hee Lee 1 3Melissa Kirkpatrick 4Brigid S Boland 1Gaurav Syal 1Ronghui Xu 5Siddharth Singh 1 2

 
     

Author information

1Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California, USA.

2Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA.

3Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, South Korea.

4Department of Pharmacy, University of California San Diego, La Jolla, California, USA.

5Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.

Abstract

Background: Although studies have compared on-treatment effectiveness of infliximab and vedolizumab in patients with ulcerative colitis (UC), there has been limited comparison of treatment sequencing and long-term patient-centred outcomes.

Aim: To compare infliximab-first and vedolizumab-first strategy in biologic-naïve patients with UC.

Methods: We conducted a retrospective cohort study in biologic-naïve patients with UC who were treated first with either infliximab or vedolizumab between 2015 and 2021 and followed over 30 months following initiation. Primary outcomes were the number of hospitalisations, corticosteroid courses and serious infections with either strategy (regardless of switch to alternative therapies) within 30 months. We matched the groups 1:1 through cardinality matching, and fit logistic and zero-inflated negative binomial models to compare outcomes.

Results: We included 181 patients (94 vedolizumab-first and 87 infliximab-first treatment strategy). Of these, 144 were matched 1:1. There was no significant difference in the incidence of IBD-related hospitalisations (incidence rate ratio [IRR], 1.98 [95% CI, 0.64-6.10]), corticosteroid courses (0.66 [0.38-1.15]) and serious infections (5.26 [0.62-45.45]), with comparable incidence of medication switches to alternative advanced therapies (1.08 [0.42-2.81]). At 30 months, there was no difference in proportion of patients in clinical remission (69.4% vs. 76.4%; p = 0.45) and endoscopic remission (55.6% vs. 65.3%; p = 0.36).

Conclusion: In patients with UC, long-term effectiveness and safety outcomes are comparable with infliximab-first and vedolizumab-first treatment strategies at 30 months. This can help to guide selection of treatment strategies in patients with UC.

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