Esophagus to Small Intestine
Aliment Pharmacol Ther. 2022;55(4):380–8
Systematic review with meta-analysis: The effectiveness of either ustekinumab or vedolizumab in patients with Crohn’s disease refractory to anti-tumor necrosis factor
Background: Ustekinumab and vedolizumab are commonly used after anti-tumor necrosis factor (TNF) failure in patients with Crohn’s disease (CD). No randomized controlled trial has compared these drugs.
Aims: To compare the effectiveness of ustekinumab and vedolizumab in CD patients refractory to anti-TNF.
Methods: From PubMed, Embase and the Cochrane Library, through March 27, 2021, studies were identified that compared ustekinumab and vedolizumab in patients with CD refractory to anti-TNF. The main outcomes were clinical remission and steroid-free clinical remission at weeks 14 and 52. Secondary outcomes were biological remission and treatment persistence. The authors computed pooled odds ratios (ORs) and 95% confidence intervals (CIs) using random effects meta-analysis.
Results: They identified 1513 reports. Among them, 38 studies were assessed for eligibility and 5 studies were included. All studies included were of high quality: 4 were retrospective and 1 was prospective. Among 1026 patients, 659 received ustekinumab and 367 received vedolizumab. At week 14, clinical remission (OR = 1.36; 95% CI: 0.74–2.47; I2 = 50%), steroid-free clinical remission (OR = 1.24; 95% CI: 0.79–1.92; I2 = 52%) and biological remission (OR = 0.80; 95% CI: 0.50–1.28; I2 = 0%) rates were similar between the 2 treatments. At week 52, ustekinumab was associated with higher rates of clinical remission (OR = 1.87; 95% CI: 1.18–2.98; I2 = 0%), steroid-free clinical remission (OR = 1.56; 95% CI: 1.23–1.97; I2 = 0%), biological remission (OR = 1.86; 95% CI: 1.03–3.37; I2 = 29%) and treatment persistence (OR = 2.37; 95% CI: 1.56–3.62; I2 = 0%).
Conclusion: In patients with Crohn’s disease refractory to anti-tumor necrosis factor, ustekinumab and vedolizumab are similarly effective in induction, but as maintenance treatment, ustekinumab appears to be more effective than vedolizumab.