Comparative Effectiveness of Biologics for Endoscopic Healing of the Ileum and Colon in Crohn's Disease.

Abstract

INTRODUCTION:

We compared the efficacy of adalimumab, infliximab, ustekinumab, and vedolizumab on the ability to achieve endoscopic healing (EH) after 1 year of therapy in moderate-severe Crohn's disease (CD).

METHODS:

This was a pooled analysis of patient-level data from 299 patients with CD from 4 clinical trials. Proportions of patients treated with each biologic were compared for achieving 1-year complete EH (Simple Endoscopic Score for CD [SES-CD] <3) and ileal and colonic EH separately (SES-CD = 0). Multivariate logistic regression was used to model the relationship between biologics and 1-year outcomes and adjusted for disease duration, concomitant corticosteroid use, and prior antitumor necrosis factor failure.

RESULTS:

Compared with vedolizumab (4/56 [7.1%]), adalimumab (17/61 [27.9%], adjusted odds ratio [OR]: 5.79, 95% confidence interval [CI]: 1.77-18.95, P = 0.004) and infliximab (39/141 [27.7%], aOR: 4.59, 95% CI: 1.48-14.22, P = 0.008) had superior rates of 1-year EH. No significant difference was observed between vedolizumab and ustekinumab. Similar results were observed among biologic-naive patients. Among patients with baseline ileal SES-CD ≥3, no significant differences were observed between biologics for 1-year ileal EH. However, for large (>0.5 cm) ileal ulcers, infliximab (20/49 [40.8%]) had superior rates of no ileal ulcers compared with vedolizumab (2/23 [8.7%], aOR: 5.39, 95% CI: 1.03-28.05, P = 0.045). No other differences were observed. For colonic disease, compared with ustekinumab (9/31 [29.0%]), adalimumab (30/48 [62.5%], aOR: 3.97, 95% CI: 1.45-10.90, P = 0.007) had superior rates of 1-year EH in the colon, with similar trends observed for infliximab (55/105 [52.4%], aOR: 2.08, 95% CI: 0.82-5.27, P = 0.121). No other differences were observed.

DISCUSSION:

In this post hoc analysis, TNF-α antagonists were overall superior to vedolizumab and ustekinumab for achieving 1-year EH in moderate-severe CD patients.

• Authors: Neeraj Narula, Emily C L Wong, Parambir S Dulai, John K Marshall, Vipul Jairath, Walter Reinisch
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 117 Issue 7 Pg. 1106-1117 (07 01 2022) ISSN: 1572-0241 [Electronic] United States
• PMID: 35435862 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 by The American College of Gastroenterology.

Chemical References

• Biological Products
• Tumor Necrosis Factor Inhibitors
• Infliximab
• Ustekinumab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Biological Products (therapeutic use)
• Colon (pathology)
• Crohn Disease (pathology)
• Humans
• Ileum (pathology)
• Infliximab (therapeutic use)
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors
• Ulcer (chemically induced)
• Ustekinumab (therapeutic use)