Studies Point to Several Options for Ulcerative Colitis After Anti-TNF Failure

SAN FRANCISCO — Research presented at the annual Crohn’s and Colitis Congress included studies comparing the effectiveness of vedolizumab (Entyvio) versus ustekinumab (Stelara) and of each biologic against Janus kinase (JAK) inhibitors in ulcerative colitis patients who had failed anti-tumor necrosis factor (TNF) therapy.

Ustekinumab and Vedolizumab Offer Similar Benefits

Clinical outcomes for ulcerative colitis patients with a prior anti-TNF therapy failure appeared similar with ustekinumab versus vedolizumab, according to a systematic review and meta-analysis.

Hospitalization rates were no different for those who took ustekinumab or vedolizumab (OR 1.16, 95% CI 0.66-2.03, P=0.60), reported Bisher Sawaf, MD, of the University of Toledo in Ohio, and colleagues, and the same was true for corticosteroid-free remission rates (OR 0.93, 95% CI 0.48-1.78, P=0.82) and surgical interventions (OR 0.95, 95% CI 0.51-1.78, P=0.86).

About a third of ulcerative colitis patients inadequately respond to anti-TNF drugs, necessitating treatment with other biologics or with JAK inhibitors, the researchers wrote. “Further research is necessary to identify predictive factors that may influence the efficacy of both biological agents,” they added.

For this study, Sawaf and colleagues searched PubMed, Embase, and Web of Science and included three retrospective cohort studies that compared clinical outcomes in ulcerative colitis patients who were treated with vedolizumab or ustekinumab after having failed an anti-TNF therapy. Among 588 patients in the retrospective cohort studies, 51.2% took vedolizumab and 48.1% took ustekinumab.

JAK inhibitors Match Vedolizumab

JAK inhibitors appeared to be just as effective as vedolizumab in adults with ulcerative colitis who had failed a previous anti-TNF therapy, according to another systematic review and meta-analysis.

There were no significant differences between the treatment groups in steroid-free remission rates (OR 2.10, 95% CI 0.67-6.52, P=0.20) or overall clinical remission rates (OR 1.15, 95% CI 0.65-2.02, P=0.64), reported Shahem Abbarh, MBBS, MRCP, of MedStar Health in Baltimore, and colleagues.

Across PubMed, Embase, and Web of Science, the researchers identified five studies that compared clinical outcomes with JAK inhibitors versus vedolizumab for ulcerative colitis patients. Four studies looked at tofacitinib (Xeljanz) and one looked at filgotinib. Among 933 total patients, 44.7% received a JAK inhibitor, and 55.3% received vedolizumab.

JAK Inhibitors Best Ustekinumab for Endoscopic Remission Rates

JAK inhibitors could be a better option compared with ustekinumab for ulcerative colitis patients who previously took an anti-TNF agent, according to results from a systematic review and meta-analysis.

Patients who took JAK inhibitors were more likely to achieve endoscopic remission than those who took ustekinumab (OR 3.40, 95% CI 1.51-7.63, P=0.003) following anti-TNF therapy failure, Abbarh and colleagues reported in a separate poster.

Incidence of adverse events was not significantly different between the two groups (OR 1.73, 95% CI 0.87-3.41, P=0.12).

The study findings suggest “that JAK inhibitors may be valuable alternative treatment options for bio-exposed ulcerative colitis patients,” the researchers concluded.

Abbarh and colleagues included three retrospective cohort studies identified from PubMed, Embase, and Web of Science, which compared endoscopic remission rates and adverse events for ulcerative colitis patients treated with JAK inhibitors or ustekinumab after failure of anti-TNF therapies. The 416 patients received upadacitinib (Rinvoq; 16.8%), tofacitinib (29.1%), or ustekinumab (54.1%).

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