Real-World Comparison of the Effectiveness between Ustekinumab and Vedolizumab in Patients with Ulcerative Colitis Exposed to at least One Anti-TNF Agent

Both vedolizumab and ustekinumab can be considered for the treatment of ulcerative colitis UC, but head-to-head trials are lacking. We aimed to compare the effectiveness of vedolizumab and ustekinumab after anti-tumour necrosis factor anti-TNF failure in UC patients. In this multicentre study, we included consecutive adult patients with UC, with partial Mayo score >2 and prior anti-TNF exposure, treated with vedolizumab or ustekinumab between January 2019 and August 2022. Comparisons were performed using propensity score analyses inverse probability of treatment weighting. Among a total of 293 patients included, 151 and 142 received vedolizumab and ustekinumab, respectively. After propensity score analysis, steroid-free clinical remission SFCR partial Mayo score ≤2 was achieved at week 16 in 38.0% and 40.3% of patients treated with vedolizumab and ustekinumab, respectively (adjusted odds ratio aOR = 1.11, 95% confidence interval 0.39-3.13, p = 0.85). Rates of SFCR in patients exposed to one, two, and three lines of biologics/small molecules among patients treated with vedolizumab and ustekinumab were respectively 53.3% vs 62.1% p = 0.52, 44.4% vs 33.8% p = 0.52, and 2.6% vs 19.1% p = 0.027. Endoscopic remission SFCR and endoscopic Mayo score ≤1 and histological remission SFCR, endoscopic remission, and Nancy histological index ≤1 at week 16 were achieved in respectively 5.3% vs 17.5% (aOR = 3.77 1.25-11.36, p = 0.018) and 2.1% vs 11.1% (aOR = 5.85 1.47-23.30, p = 0.012) in the vedolizumab and ustekinumab groups. No difference regarding the risk of drug discontinuation between the two groups (aHR = 1.03 0.51-2.08, p = 0.92) was observed. While no factor was identified for vedolizumab, primary failure to at least one biologic/small molecule (OR = 0.31 0.11-0.82, p = 0.018) was significantly associated with a decreased rate of SFCR among patients treated with ustekinumab. While no difference in terms of short-term clinical remission was observed, ustekinumab appears to be more effective than vedolizumab in inducing endoscopic and histological remission at week 16 after failure of anti-TNFs in UC.