Austin Haynesworth, MD1, Kuan-Hung Yeh, MS1, Han Hee Lee, MD1, Melissa Kirkpatrick, PharmD1, Brigid S. Boland, MD2, Gaurav Syal, MD, MHDS3, Ronghui Xu, PhD1, Siddharth Singh, MD1 1University of California San Diego, La Jolla, CA; 2University of California San Diego, San Diego, CA; 3UC San Diego Health, La Jolla, CA
Introduction: Prior observational studies have suggested similar rates of treatment effectiveness with infliximab and vedolizumab in patients with ulcerative colitis (UC) over a short duration of follow-up. However, there has been limited comparison of long-term patient-centered outcomes with an infliximab-first vs. vedolizumab-first treatment strategy in biologic-naïve patients with UC.
Methods: We conducted a single-center, retrospective cohort study in biologic-naïve patients with UC who were treated first with an infliximab-based vs. vedolizumab-based treatment strategy between 2015-2021 and followed over 30 months after treatment initiation. Our primary outcomes were the number of hospitalizations, corticosteroid courses, and serious infections with either treatment strategy (regardless of need to switch to alternative therapies), and whether patients were in clinical and endoscopic remission at 30 months. We matched the groups 1:1 through cardinality matching, and fit logistic and zero-inflated negative binomial models to compare outcomes.
Results: We included 181 patients with UC, of whom 94 were exposed to vedolizumab-first and 87 to infliximab-first treatment strategy; of these, 144 were matched 1:1 using cardinality matching. There was no significant difference in the incidence of IBD-related hospitalizations (infliximab-first vs. vedolizumab-first treatment strategy, incidence rate ratio [IRR], 1.98 [95% CI, 0.64-6.10]), corticosteroid courses (IRR, 0.66 [0.38-1.15]) and serious infections (IRR, 5.26 [0.62-45.45]) with infliximab-first vs. vedolizumab-first treatment strategy, with comparable incidence of medication switches to alternative advanced therapies (IRR, 1.08 [0.42-2.81]). Comparable number of patients were in clinical remission (69.4% vs. 76.4%, p=0.45) and endoscopic remission (55.6% vs. 65.3%, p=0.36) with an infliximab-first vs. vedolizumab-first treatment strategy at 30 months.
Discussion: In patients with ulcerative colitis, long-term effectiveness and safety outcomes are comparable with an infliximab-first vs. vedolizumab-first treatment strategy at 30 months. This information can guide selection of treatment strategies in patients with UC.
Disclosures:
Austin Haynesworth indicated no relevant financial relationships.
Kuan-Hung Yeh indicated no relevant financial relationships.
Han Hee Lee indicated no relevant financial relationships.
Melissa Kirkpatrick indicated no relevant financial relationships.
