First-line treatment with vedolizumab linked to fewer hospitalizations, surgeries in IBD
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Key takeaways:
- Incidences of hospitalizations and surgeries were lowest with the vedolizumab-adalimumab sequence in UC and CD.
- Ustekinumab-infliximab was associated with the highest incidence of adverse outcomes in CD.
The treatment sequence of vedolizumab to adalimumab resulted in the lowest overall incidences of hospitalization and surgery in both Crohn’s disease and ulcerative colitis compared with other biologic treatment sequences, research showed.
“Despite the availability of several treatment options, some patients do not adequately respond to treatment,” Noa Krugliak Cleveland, MD, assistant professor at University of Chicago Medicine, and colleagues wrote in BMC Gastroenterology. “Following inadequate response, loss of response or intolerance to therapy, patients may switch from an initial biologic to a second-line biologic.
“Deciding the order in which to prescribe therapies is challenging owing to a lack of predictive therapeutic biomarkers and limited data on the clinical outcomes of patients with IBD receiving different sequences of biologic treatment.”
In the retrospective ROTARY part B study, Cleveland and colleagues used the Optum Clinical Database to investigate adverse clinical outcomes, including IBD-related hospitalizations and surgery, dysplasia, colorectal cancer and infection, associated with different treatment sequences in IBD.
They included electronic health record data from 1,273 patients with CD (mean age, 39.9-44.7 years; 38.2%-51.9% men) and 779 patients with UC (mean age, 41.8-47.2 years; 47%-54.7% men), who received at least two successive biologics between January 2013 and February 2020.
The researchers included adalimumab, infliximab, ustekinumab (for CD) and vedolizumab as first-line biologics and infliximab and adalimumab as second-line biologics.
According to study results, the overall incidence of hospitalizations ranged from 30.9% to 51.9% among patients with CD and 20.3% to 43% among patients with UC across all treatment sequences.
Among patients with CD, the incidences of hospitalization (51.9%), surgery (40.7%) and infection (37%) were highest with the ustekinumab-infliximab sequence, while the lowest incidence of surgery was reported for vedolizumab-adalimumab (14.6%). The overall incidences of dysplasia and CRC were less than 9% and 4%, respectively, for all treatment sequences.
Similarly, the lowest incidence of hospitalization (20.3%) in UC was reported with vedolizumab-adalimumab, which also resulted in the lowest incidences of surgery (6.3%), dysplasia (6.3%) and infection (4.7%). The incidence of CRC was below 1% for all sequences.
Further, patients with CD who received vedolizumab followed by an anti-tumor necrosis factor alpha treatment had lower odds of an adverse outcome compared with those who received two successive anti-TNF treatments (OR = 1.52; 95% CI, 1.004-1.32).
“We observed differences in the incidence of adverse clinical outcomes, generally favoring treatment with vedolizumab as a first-line biologic followed by adalimumab over anti-TNF alpha treatments or ustekinumab as first-line biologics followed by an anti-TNF alpha treatment,” Cleveland and colleagues wrote. “Whether these findings are related to the treatments or to the disease in patients who need multiple successive therapies is not known, but the possibility that the mechanisms of action of these therapies affect the biology of inflammation in these patients should be explored further.”
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