Background: Ustekinumab and vedolizumab are commonly used after anti-tumour necrosis factor (TNF) failure in patients with Crohn's disease (CD). No randomised controlled trial has compared these drugs.
Aims: To compare the effectiveness of ustekinumab and vedolizumab in CD patients refractory to anti-TNF.
Methods: From PubMed, EMBASE and the Cochrane Library, through March 27, 2021, we identified studies that compared ustekinumab and vedolizumab in patients with CD refractory to anti-TNF. The main outcomes were clinical remission and steroid-free clinical remission at weeks 14 and 52. Secondary outcomes were biological remission and treatment persistence. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) using random effects meta-analysis.
Results: We identified 1513 reports. Among them, 38 studies were assessed for eligibility and five studies were included. All studies included were of high quality: four were retrospective and one was prospective. Among 1026 patients, 659 received ustekinumab and 367 received vedolizumab. At week 14, clinical remission (OR 1.36; 95%CI: 0.74-2.47; I2 = 50%), steroid-free clinical remission (OR 1.24; 95%CI: 0.79-1.92; I2 = 52%) and biological remission (OR 0.80; 95%CI: 0.50-1.28; I2 = 0%) rates were similar between the two treatments. At week 52, ustekinumab was associated with higher rates of clinical remission (OR 1.87; 95% CI: 1.18-2.98; I2 = 0%), steroid-free clinical remission (OR 1.56; 95% CI: 1.23-1.97; I2 = 0%), biological remission (OR 1.86; 95% CI: 1.03-3.37; I2 = 29%) and treatment persistence (OR 2.37; 95% CI: 1.56-3.62; I2 = 0%).
Conclusion: In patients with CD refractory to anti-TNF, ustekinumab and vedolizumab are similarly effective in induction, but as maintenance treatment, ustekinumab appears to be more effective than vedolizumab.
© 2021 John Wiley & Sons Ltd.