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Background/Aims <p>The increasing use of biologic therapies for moderate to severe inflammatory bowel disease (IBD) highlights the importance of optimal treatment sequencing, particularly after vedolizumab (VDZ) exposure. Studies comparing the effectiveness of ustekinumab (UST) and antitumor necrosis factor (anti-TNF) agents post-VDZ are limited.</p> Methods <p>This retrospective study analyzed VDZ-experienced IBD patients treated with UST or anti-TNF (adalimumab and infliximab) from May 2019 to January 2024. We conducted a comparative analysis of the 52-week treatment persistence between UST and anti-TNF therapies, while also identifying independent predictors that influence 52-week persistence.</p> Results <p>The study included 110 participants, with 40 diagnosed with ulcerative colitis (UC) and 70 with Crohn’s disease (CD). Demographics were comparable across treatment groups. The primary discontinuation reason for VDZ was secondary non-response. Kaplan-Meier analysis revealed that UST demonstrated superior 52-week persistence in overall IBD, CD and UC patients, compared to anti-TNF. Cox regression analysis also showed UST’s superiority in overall IBD (HR: 0.15, 95% CI: 0.05–0.45, <i>p</i> &lt; 0.001), CD (HR: 0.09, 95% CI: 0.01–0.68, <i>p</i> = 0.02), and UC (HR: 0.28, 95% CI: 0.08–0.996, <i>p</i> = 0.049). The independent predictors for 52-week treatment persistence are Crohn’s disease (Odds Ratio: 7.151, 95% CI: 1.763–28.995, <i>p</i> = 0.006) and UST treatment (Odds Ratio: 7.912, 95% CI: 1.789–34.992, <i>p</i> = 0.006). Notably, UST required more frequent dosing adjustments than anti-TNF, although both treatments exhibited comparable safety profiles.</p> Conclusions <p>UST demonstrated superior 52-week treatment persistence in IBD patients previously treated with VDZ compared to anti-TNF agents, albeit with a need for more frequent dose adjustments.</p>

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Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年12月31日

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  • Horng-Yih Chiu,
  • Chia-Jung Kuo,
  • Ming-Wei Lai,
  • Ren-Chin Wu,
  • Chien-Ming Chen,
  • Cheng-Tang Chiu,
  • Yu-Bin Pan,
  • Cheng-Hsun Chiu,
  • Puo-Hsien Le

摘要

Background/Aims

The increasing use of biologic therapies for moderate to severe inflammatory bowel disease (IBD) highlights the importance of optimal treatment sequencing, particularly after vedolizumab (VDZ) exposure. Studies comparing the effectiveness of ustekinumab (UST) and antitumor necrosis factor (anti-TNF) agents post-VDZ are limited.

Methods

This retrospective study analyzed VDZ-experienced IBD patients treated with UST or anti-TNF (adalimumab and infliximab) from May 2019 to January 2024. We conducted a comparative analysis of the 52-week treatment persistence between UST and anti-TNF therapies, while also identifying independent predictors that influence 52-week persistence.

Results

The study included 110 participants, with 40 diagnosed with ulcerative colitis (UC) and 70 with Crohn’s disease (CD). Demographics were comparable across treatment groups. The primary discontinuation reason for VDZ was secondary non-response. Kaplan-Meier analysis revealed that UST demonstrated superior 52-week persistence in overall IBD, CD and UC patients, compared to anti-TNF. Cox regression analysis also showed UST’s superiority in overall IBD (HR: 0.15, 95% CI: 0.05–0.45, p < 0.001), CD (HR: 0.09, 95% CI: 0.01–0.68, p = 0.02), and UC (HR: 0.28, 95% CI: 0.08–0.996, p = 0.049). The independent predictors for 52-week treatment persistence are Crohn’s disease (Odds Ratio: 7.151, 95% CI: 1.763–28.995, p = 0.006) and UST treatment (Odds Ratio: 7.912, 95% CI: 1.789–34.992, p = 0.006). Notably, UST required more frequent dosing adjustments than anti-TNF, although both treatments exhibited comparable safety profiles.

Conclusions

UST demonstrated superior 52-week treatment persistence in IBD patients previously treated with VDZ compared to anti-TNF agents, albeit with a need for more frequent dose adjustments.