Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study
Abstract Background/Aims The increasing use of biologic therapies for moderate to severe inflammatory bowel disease (IBD) highlights the importance of optimal treatment sequencing, particularly after vedolizumab (VDZ) exposure. Studies comparing the effectiveness of ustekinumab (UST) and antitumor n...
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2024-12-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-024-03577-1 |
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| author | Horng-Yih Chiu Chia-Jung Kuo Ming-Wei Lai Ren-Chin Wu Chien-Ming Chen Cheng-Tang Chiu Yu-Bin Pan Cheng-Hsun Chiu Puo-Hsien Le |
| author_facet | Horng-Yih Chiu Chia-Jung Kuo Ming-Wei Lai Ren-Chin Wu Chien-Ming Chen Cheng-Tang Chiu Yu-Bin Pan Cheng-Hsun Chiu Puo-Hsien Le |
| author_sort | Horng-Yih Chiu |
| collection | DOAJ |
| description | Abstract Background/Aims The increasing use of biologic therapies for moderate to severe inflammatory bowel disease (IBD) highlights the importance of optimal treatment sequencing, particularly after vedolizumab (VDZ) exposure. Studies comparing the effectiveness of ustekinumab (UST) and antitumor necrosis factor (anti-TNF) agents post-VDZ are limited. Methods This retrospective study analyzed VDZ-experienced IBD patients treated with UST or anti-TNF (adalimumab and infliximab) from May 2019 to January 2024. We conducted a comparative analysis of the 52-week treatment persistence between UST and anti-TNF therapies, while also identifying independent predictors that influence 52-week persistence. Results The study included 110 participants, with 40 diagnosed with ulcerative colitis (UC) and 70 with Crohn’s disease (CD). Demographics were comparable across treatment groups. The primary discontinuation reason for VDZ was secondary non-response. Kaplan-Meier analysis revealed that UST demonstrated superior 52-week persistence in overall IBD, CD and UC patients, compared to anti-TNF. Cox regression analysis also showed UST’s superiority in overall IBD (HR: 0.15, 95% CI: 0.05–0.45, p < 0.001), CD (HR: 0.09, 95% CI: 0.01–0.68, p = 0.02), and UC (HR: 0.28, 95% CI: 0.08–0.996, p = 0.049). The independent predictors for 52-week treatment persistence are Crohn’s disease (Odds Ratio: 7.151, 95% CI: 1.763–28.995, p = 0.006) and UST treatment (Odds Ratio: 7.912, 95% CI: 1.789–34.992, p = 0.006). Notably, UST required more frequent dosing adjustments than anti-TNF, although both treatments exhibited comparable safety profiles. Conclusions UST demonstrated superior 52-week treatment persistence in IBD patients previously treated with VDZ compared to anti-TNF agents, albeit with a need for more frequent dose adjustments. |
| format | Article |
| id | doaj-art-a369d111c56e45d88bb9a19fe9341c17 |
| institution | Kabale University |
| issn | 1471-230X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-a369d111c56e45d88bb9a19fe9341c172025-01-05T12:32:08ZengBMCBMC Gastroenterology1471-230X2024-12-012411810.1186/s12876-024-03577-1Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort studyHorng-Yih Chiu0Chia-Jung Kuo1Ming-Wei Lai2Ren-Chin Wu3Chien-Ming Chen4Cheng-Tang Chiu5Yu-Bin Pan6Cheng-Hsun Chiu7Puo-Hsien Le8School of Medicine, Chang Gung UniversityDepartment of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial HospitalInflammatory Bowel Disease Center, Chang Gung Memorial HospitalInflammatory Bowel Disease Center, Chang Gung Memorial HospitalInflammatory Bowel Disease Center, Chang Gung Memorial HospitalDepartment of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial HospitalBiostatistics Unit, Clinical Trial Center, Linkou Branch, Chang Gung Memorial HospitalChang Gung Microbiota Therapy Center, Chang Gung Memorial HospitalDepartment of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial HospitalAbstract Background/Aims The increasing use of biologic therapies for moderate to severe inflammatory bowel disease (IBD) highlights the importance of optimal treatment sequencing, particularly after vedolizumab (VDZ) exposure. Studies comparing the effectiveness of ustekinumab (UST) and antitumor necrosis factor (anti-TNF) agents post-VDZ are limited. Methods This retrospective study analyzed VDZ-experienced IBD patients treated with UST or anti-TNF (adalimumab and infliximab) from May 2019 to January 2024. We conducted a comparative analysis of the 52-week treatment persistence between UST and anti-TNF therapies, while also identifying independent predictors that influence 52-week persistence. Results The study included 110 participants, with 40 diagnosed with ulcerative colitis (UC) and 70 with Crohn’s disease (CD). Demographics were comparable across treatment groups. The primary discontinuation reason for VDZ was secondary non-response. Kaplan-Meier analysis revealed that UST demonstrated superior 52-week persistence in overall IBD, CD and UC patients, compared to anti-TNF. Cox regression analysis also showed UST’s superiority in overall IBD (HR: 0.15, 95% CI: 0.05–0.45, p < 0.001), CD (HR: 0.09, 95% CI: 0.01–0.68, p = 0.02), and UC (HR: 0.28, 95% CI: 0.08–0.996, p = 0.049). The independent predictors for 52-week treatment persistence are Crohn’s disease (Odds Ratio: 7.151, 95% CI: 1.763–28.995, p = 0.006) and UST treatment (Odds Ratio: 7.912, 95% CI: 1.789–34.992, p = 0.006). Notably, UST required more frequent dosing adjustments than anti-TNF, although both treatments exhibited comparable safety profiles. Conclusions UST demonstrated superior 52-week treatment persistence in IBD patients previously treated with VDZ compared to anti-TNF agents, albeit with a need for more frequent dose adjustments.https://doi.org/10.1186/s12876-024-03577-1Inflammatory bowel diseaseVedolizumabUstekinumabAnti-TNFPersistence |
| spellingShingle | Horng-Yih Chiu Chia-Jung Kuo Ming-Wei Lai Ren-Chin Wu Chien-Ming Chen Cheng-Tang Chiu Yu-Bin Pan Cheng-Hsun Chiu Puo-Hsien Le Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study BMC Gastroenterology Inflammatory bowel disease Vedolizumab Ustekinumab Anti-TNF Persistence |
| title | Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study |
| title_full | Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study |
| title_fullStr | Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study |
| title_full_unstemmed | Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study |
| title_short | Superior persistence of ustekinumab compared to anti-TNF in vedolizumab-experienced inflammatory bowel diseases patients: a real-world cohort study |
| title_sort | superior persistence of ustekinumab compared to anti tnf in vedolizumab experienced inflammatory bowel diseases patients a real world cohort study |
| topic | Inflammatory bowel disease Vedolizumab Ustekinumab Anti-TNF Persistence |
| url | https://doi.org/10.1186/s12876-024-03577-1 |
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