Comparison of Short- and Long-Term Effectiveness between Anti-TNF and Ustekinumab after Vedolizumab Failure as First-Line Therapy in Crohn's Disease: A Multi-Center Retrospective Cohort Study

• Published in: Journal of clinical medicine Vol. 12; no. 7; p. 2503
• Main Authors: Albshesh, Ahmad, Bannon, Lian, Sharar Fischler, Tali, Truyens, Marie, Vavricka, Stephan R, Tepes, Katja, Pugliese, Daniela, Savarino, Edoardo V, Zittan, Eran, Drobne, David, Roblin, Xavier, Bar-Gil Shitrit, Ariella, Armuzzi, Alessandro, Lobaton, Triana, Maharshak, Nitsan, Yanai, Henit, Ben-Horin, Shomron, Kopylov, Uri
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 26.03.2023; MDPI
• Subjects: Analysis; Care and treatment; Clinical medicine; Cohort analysis; Crohn's disease; Crohns disease; Diagnosis; Endoscopy; Immunotherapy; Patients; Remission (Medicine); Steroids; Surgery; Survival analysis; Tumor necrosis factor; Tumor necrosis factor-TNF; Israel; drug positioning; vedolizumab; ustekinumab; treatment failure; treatment response; Crohn’s disease; anti-TNF
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12072503

The effectiveness of anti-TNF or ustekinumab (UST) as a second-line biologic after vedolizumab (VDZ) failure has not yet been described. In this retrospective multicenter cohort study, We aim to investigate the effectiveness of anti-TNF and UST as second-line therapy in patients with Crohn's disease (CD) who failed VDZ as a first-line treatment. The primary outcome was clinical response at week 16-22. Secondary outcomes included the rates of clinical remission, steroid-free clinical remission, CRP normalization, and adverse events. Fifty-nine patients who failed on VDZ as a first-line treatment for CD were included; 52.8% patients received anti-TNF and 47.2% UST as a second-line therapy. In initial period (Week 16-22), the clinical response and remission rate was similar between both groups: 61.2% vs. 68%, = 0.8 and 48.3% vs. 56%, = 0.8 on anti-TNF and UST therapy, respectively. Furthermore, in the maintenance period the rate was similar: 75% vs. 82.3%, = 0.8 and 62.5% vs. 70.5%, = 0.8, respectively. Of the patients, 12 out of the 59 stopped the therapy, without a significant difference between the two groups ( = 0.6). Second-line biological therapy after VDZ failure therapy was effective in >60% of the patients with CD. No differences in effectiveness were detected between the use of anti-TNF and UST as a second line.