Real-World Efficacy of Ustekinumab versus Vedolizumab for Ulcerative Colitis: Differences between Short- and Long-Term Outcomes Based on Endoscopic Remission

Introduction: Ustekinumab (UST) and vedolizumab (VED) are effective for ulcerative colitis (UC), but long-term real-world data, particularly regarding endoscopic remission, remain limited. Methods: Patients with UC who were treated with UST or VED at two tertiary centers were enrolled in this retrospective study. Baseline imbalances were adjusted using inverse probability of treatment weighting. The primary outcome was the endoscopic remission rates (Mayo Endoscopic Subscore [MES] 0 or 1, and MES 0 alone) at 1 year and 2 years. Secondary outcomes included clinical remission rates and treatment persistence. Results: Overall, 197 patients were analyzed; 96 received UST, and 101 received VED. The median observation period was 2.5 years. Clinical remission rates did not differ between the two groups. Treatment persistence was higher with UST than with VED (HR 1.85; 95% CI, 1.13–3.02; p = 0.014), particularly in the early period. At 1 year, there were no significant differences in endoscopic remission rates for MES 0 or 1 and MES 0 alone between the two groups. At 2 years, patients treated with UST were significantly more likely to achieve MES 0 or 1 (UST, 45.0% vs VED, 19.8%; OR for VED vs UST, 0.30; 95% CI, 0.11–0.82; p = 0.019), whereas achievement of MES 0 alone did not differ significantly. Conclusion: UST was associated with a higher rate of achieving MES 0 or 1, while deep remission rates were comparable. This may explain a more pronounced difference in treatment persistence in the short-term phase, with the difference decreasing over time.