| Autor: |
García, María José, Rivero, Montserrat, Fernández-Clotet, Agnès, Francisco, Ruth de, Sicilia, Beatriz, Mesonero, Francisco, Castro, María Luisa de, Casanova, María José, Bertoletti, Federico, García-Alonso, Francisco Javier, López-García, Alicia, Vicente, Raquel, Calvet, Xavier, Acosta, Manuel Barreiro-de, Rosique, Juan Ferrer, Trastoy, Pilar Varela, Nuñez, Alejandro, Ricart, Elena, Riestra, Sabino, García, Lara Arias |
| Zdroj: |
Journal of Crohn's & Colitis; Jan2024, Vol. 18 Issue 1, p65-74, 10p |
| Abstrakt: |
Background Both vedolizumab and ustekinumab are approved for the management of Crohn's disease [CD]. Data on which one would be the most beneficial option when anti-tumour necrosis factor [anti-TNF] agents fail are limited. Aims To compare the durability, effectiveness, and safety of vedolizumab and ustekinumab after anti-TNF failure or intolerance in CD. Methods CD patients from the ENEIDA registry who received vedolizumab or ustekinumab after anti-TNF failure or intolerance were included. Durability and effectiveness were evaluated in both the short and the long term. Effectiveness was defined according to the Harvey–Bradshaw index [HBI]. The safety profile was compared between the two treatments. The propensity score was calculated by the inverse probability weighting method to balance confounder factors. Results A total of 835 patients from 30 centres were included, 207 treated with vedolizumab and 628 with ustekinumab. Dose intensification was performed in 295 patients. Vedolizumab [vs ustekinumab] was associated with a higher risk of treatment discontinuation (hazard ratio [HR] 2.55, 95% confidence interval [CI]: 2.02–3.21), adjusted by corticosteroids at baseline [HR 1.27; 95% CI: 1.00–1.62], moderate–severe activity in HBI [HR 1.79; 95% CI: 1.20–2.48], and high levels of C-reactive protein at baseline [HR 1.06; 95% CI: 1.02–1.10]. The inverse probability weighting method confirmed these results. Clinical response, remission, and corticosteroid-free clinical remission were higher with ustekinumab than with vedolizumab. Both drugs had a low risk of adverse events with no differences between them. Conclusion In CD patients who have failed anti-TNF agents, ustekinumab seems to be superior to vedolizumab in terms of durability and effectiveness in clinical practice. The safety profile is good and similar for both treatments. [ABSTRACT FROM AUTHOR] |
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