• Tristan Townsend, Violeta Razanskaite, Susanna Dodd, Daniel Storey, Stephanie Michail, James Morgan, Michael Davies, Douglas Penman, Christopher Watters, Mira Swaminathan, Joseph Sabine, Adam Chapman, Philip J Smith, Paul K Flanagan, Ian Reilly, Keith Bodger, and Sreedhar Subramanian.
• Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK.
• Aliment. Pharmacol. Ther. 2020 Oct 1; 52 (8): 1341-1352.

BackgroundAnti-tumour necrosis factor (TNF) agents are effective in Crohn's disease but some patients lose response and require alternative biologic therapy. There are few data on comparative effectiveness of vedolizumab and ustekinumab in this setting.AimTo compare the effectiveness of ustekinumab and vedolizumab in anti-TNF-refractory Crohn's disease over 12 months.MethodsPatients commencing ustekinumab or vedolizumab for anti-TNF-refractory Crohn's disease with minimum follow-up of 12 months were included. The primary outcome measure was the difference in steroid-free remission rates at end of induction (2 months) and at 12 months. We also assessed rates of clinical response and remission, treatment persistence, surgery and adverse events in both groups. We performed logistic regression analysis to assess factors associated with steroid-free remission and clinical response and remission.ResultsWe included 85 patients commencing vedolizumab and 45 commencing ustekinumab. In an unadjusted model, rates of steroid-free and clinical remission were significantly higher among ustekinumab-treated patients. After adjusting for confounders, steroid-free remission was higher among ustekinumab-treated patients at 2 months (odds ratio, OR 2.79, 95% confidence interval, CI 1.06-7.39, P = 0.038) and 12 months (OR 2.01, 95% CI 0.89-4.56, P = 0.095). More patients treated with ustekinumab remained on therapy at the end of 12 months (84.4% vs 61.5%, P = 0.007).ConclusionsUstekinumab appeared more effective in treating anti-TNF-refractory Crohn's disease and more patients persisted with therapy.© 2020 John Wiley & Sons Ltd.

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