Ustekinumab may be superior to Vedolizumab for the treatment of Crohn’s disease
1. In patients with Crohn’s disease (CD) of the pouch following ileal-pouch anal anastomosis (IPAA) for medically-refractory ulcerative colitis (UC), the clinical response at 3 and 6 months was significantly greater for ustekinumab (UST) compared to vedolizumab (VDZ).
Evidence Rating Level: 2 (Good)
A significant number of patients living with UC will eventually require IPAA, from which as high as 17% of patients will develop CD of the pouch. Historically, management of CD of the pouch has been limited to antitumour necrosis factor alpha therapies such as infliximab. However, the efficacy and safety of newer inflammatory bowel disease (IBD) therapies in the management of CD of the pouch, including UST and VDZ, have not been investigated. This retrospective cohort study therefore sought to investigate the clinical and endoscopic outcomes associated with the management of CD of the pouch with UST and VDZ. 104 adult patients who received either UST (N = 77; mean[SD] age, 44.4[14.6] years) or VDZ (N = 57; mean[SD] age, 46.9[15.3] years) or both for CD of the pouch following IPAA for UC from several centres across the United States were included in this study. The primary outcome was clinical response after 3 and 6 months, with secondary outcomes including clinical remission and endoscopic outcomes. At 3 months, the clinical response was greater in UST at 62% (48/77) compared with 53% (30/57) for VDZ (P = .34). Similarly, at 6 months the clinical response was 56% (43/77) for UST and 46% (26/57) for VDZ (P = .32). Endoscopic response was also greater with UST (41% [25/61]) after a median follow-up of 1 year compared with VDZ (27% [12/44]). Under multivariate analysis, UST had a significantly greater 3-month clinical response (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.13-6.56, P = .025) and 6-month clinical response (OR 2.53, 95% CI: 1.01-6.29, P = .046) compared to VDZ. Overall, this study found that among patients with CD of the pouch following IPAA for UC, the clinical response with UST was significantly greater compared with VDZ at 3 and 6 months.
Click to read the study in IBD
Image: PD
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