A real-world study of vedolizumab versus infliximab in patients with moderate to severe ulcerative colitis

Abstract

Objective To compare the efficacy and safety of vedolizumab (VDZ) and infliximab (IFX) for moderate to severe ulcerative colitis (UC) patients through a multicenter retrospective cohort study. Methods All patients with moderate to severe UC who were naive to biologic agents and treated with IFX or VDZ for at least 14 weeks at 3 hospitals in Southwest China between January 2021 and January 2023 were retrospectively enrolled. The efficacy evaluation indicators, including steroid-free clinical remission rates, clinical remission rates and endoscopic remission rates at weeks 14 and 52 were compared between the 2 groups. The occurrence of adverse events during treatment were recorded. Taking whether mucosal healing could be achieved after 14 and 52 weeks of treatment as the dependent variable, firstly, univariate analysis was performed to analyze the risk factors affecting mucosal healing at weeks 14 and 52, and then multivariate logistic regression analysis was applied to identify the independent risk factors of mucosal healing at the 2 time points. Results A total of 151 patients with moderate to severe UC were included, after propensity score matching (PSM), each group included 57 patients. There were no significant differences in the steroid-free clinical remission rate and clinical remission rate between the 2 groups at weeks 14 and 52 (P>0.05). The endoscopic remission rate at week 14 was significantly higher in the VDZ group than the IFX group [40.4% (23/57) vs 22.8% (13/57), P=0.044], but no such difference was observed at week 52 [64.5% (20/31) vs 59.5% (22/37), P=0.669]. Multivariate logistic regression analysis showed that left-sided disease (E2) [vs pancolitis (E3)](OR=0.46, 95%CI: 0.21~0.98, P=0.045) was independent risk factor for mucosal healing at week 14 and a disease duration ≥36 months (OR=0.25, 95%CI: 0.09~0.66, P=0.005) was independent risk factor for mucosal healing at week 52. No statistical difference was observed in the incidence of adverse events between the 2 groups (1.8% vs 7.0%, P=0.360). Conclusion VDZ and IFX have similar efficacy and safety, and both can be used as first-line options for patients with moderate to severe UC.

Keywords

• ulcerative colitis
• vedolizumab
• infliximab