ABSTRACT Background Real‐world evidence is needed to understand the comparative effectiveness of biologics in Crohn's disease (CD) under routine‐care conditions. We conducted a pooled analysis of individual patient data from prospective German CD registries (BioCrohn, RUN‐CD, VEDO‐IBD) in the UMBRELLA‐IBD data warehouse. Methods We included 1567 adults with CD who initiated anti‐TNF therapy (adalimumab or infliximab), ustekinumab or vedolizumab. The main outcome was clinical remission (CR) at 24 months (HBI ≤ 4). Additional outcomes included HBI, EQ‐VAS and treatment persistence over time. Between‐group comparisons used propensity‐score‐based inverse probability of treatment weighting. Results After weighting, CR following induction was observed in a slightly higher proportion of patients initiating anti‐TNF therapy (74.5%) than ustekinumab (69.4%) or vedolizumab (65.3%) ( p = 0.035). Clinical response was 77.9%, 73.5% and 67.8%, respectively ( p = 0.015). At 24 months, CR rates were similar in magnitude (anti‐TNF, 53.4%; ustekinumab, 63.5%; vedolizumab, 58.7%) but were higher with ustekinumab than anti‐TNF ( p = 0.004). Over 24 months, treatment persistence differed (log‐rank p < 0.001) and was highest for adalimumab (81.4%), lowest for infliximab (66.6%), and intermediate for ustekinumab (78.6%) and vedolizumab (76.9%). HBI decreased and remained low, and EQ‐VAS improved, with no relevant between‐group differences. Conclusion Overall effectiveness in CD was high, with only small differences between biologic therapies. At the end of induction, CR was slightly higher with anti‐TNF therapy than with vedolizumab, whereas at 24 months it was slightly higher with ustekinumab than with anti‐TNF. Marked differences in treatment persistence among the evaluated biologics suggest that persistence as an endpoint is not fully explained by CR alone.
Bokemeyer et al. (Mon,) studied this question.