Superior Effectiveness of Tofacitinib Compared to Vedolizumab in Anti-TNF-experienced Ulcerative Colitis Patients: A Nationwide Dutch Registry Study

被引：26

作者：

Straatmijer, Tessa ^{[1
,2
]}

Biemans, Vince B. C. ^{[3
]}

Visschedijk, Marijn ^{[4
]}

Hoentjen, Frank ^{[5
,6
]}

de Vries, Annemarie ^{[7
]}

van Bodegraven, Adriaan A. ^{[8
]}

Bodelier, Alexander ^{[9
]}

de Boer, Nanne K. H. ^{[10
]}

Dijkstra, Gerard ^{[4
]}

Festen, Noortje ^{[4
]}

Horjus, Carmen ^{[11
]}

Jansen, Jeroen M. ^{[12
]}

Jharap, Bindia ^{[13
]}

Mares, Wout ^{[14
]}

van Schaik, Fiona D. M. ^{[15
]}

Ponsioen, Cyriel ^{[1
]}

Romkens, Tessa ^{[16
]}

Srivastava, Nidhi ^{[17
]}

van der Voorn, Michael M. P. J. A. ^{[18
]}

West, Rachel ^{[19
]}

van der Woude, Janneke ^{[7
]}

Wolvers, Marije D. J. ^{[20
]}

Pierik, Marieke ^{[21
]}

van der Meulen-de Jong, Andrea E. ^{[2
]}

Duijvestein, Marjolijn ^{[5
]}

机构：

[1] Univ Amsterdam, Amsterdam Gastroenterol Endocrinol Metab AGEM Res, Dept Gastroenterol & Hepatol, Amsterdam UMC, Amsterdam, Netherlands

[2] Leiden Univ, Med Ctr, Dept Gastroenterol & Hepatol, Leiden, Netherlands

[3] St Antonius Hosp, Nieuwegein, Netherlands

[4] Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands

[5] Radboud Univ Nijmegen, Med Ctr, Dept Gastroenterol, Nijmegen, Netherlands

[6] Univ Alberta, Div Gastroenterol, Edmonton, AB, Canada

[7] Erasmus MC, Rotterdam, Netherlands

[8] Zuyderland Med Ctr, Dept Gastroenterol Geriatr Internal & Intens Care, Heerlen Sittard Geleen, Netherlands

[9] Amphia Hosp, Breda, Netherlands

[10] Vrije Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam Gastroenterol Endocrinol Metab AGEM Res, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[11] Rijnstate, Arnhem, Netherlands

[12] OLVG, Amsterdam, Netherlands

[13] Meander Med Ctr, Amersfoort, Netherlands

[14] Ziekenhuis Geldersche Vallei, Ede, Netherlands

[15] Univ Med Ctr Utrecht, Utrecht, Netherlands

[16] Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands

[17] Haaglanden Med Ctr, The Hague, Netherlands

[18] Haga Ziekenhuis, The Hague, Netherlands

[19] Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands

[20] Amsterdam UMC, Dept Epidemiol & Data Sci, Amsterdam, Netherlands

[21] Maastricht Univ, Med Ctr, Maastricht, Netherlands

来源：

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY | 2023年 / 21卷 / 01期

关键词：

Real-world Data; Tofacitinib; Ulcerative Colitis; Vedolizumab; INFLAMMATORY-BOWEL-DISEASE; MAINTENANCE THERAPY; INDUCTION; MECHANISM;

D O I：

10.1016/j.cgh.2022.04.038

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Clinicians face difficulty in when and in what order to position biologics and Janus kinase in-hibitors in patients with anti-tumor necrosis factor-alpha (TNF) refractory ulcerative colitis (UC). We aimed to compare the effectiveness and safety of vedolizumab and tofacitinib in anti-TNF-exposed patients with UC in our prospective nationwide Initiative on Crohn and Colitis Registry. METHODS: Patients with UC who failed anti-TNF treatment and initiated vedolizumab or tofacitinib treatment were identified in the Initiative on Crohn and Colitis Registry in the Netherlands. We selected patients with both clinical as well as biochemical or endoscopic disease activity at initiation of therapy. Patients previously treated with vedolizumab or tofacitinib were excluded. Corticosteroid-free clinical remission (Simple Clinical Colitis Activity Index 52), biochemical remission (C-reactive protein 55 mg/L or fecal calprotectin 5250 mg/g), and safety outcomes were compared after 52 weeks of treatment. Inverse propensity score-weighted comparison was used to adjust for confounding and selection bias. RESULTS: Overall, 83 vedolizumab-and 65 tofacitinib-treated patients were included. Propensity score -weighted analysis showed that tofacitinib-treated patients were more likely to achieve corticosteroid-free clinical remission and biochemical remission at weeks 12, 24, and 52 compared with vedolizumab-treated patients (odds ratio [OR], 6.33; 95% confidence interval [CI], 3.81-10.50; P < .01; OR, 3.02; 95% CI, 1.89-4.84; P < .01; and OR, 1.86; 95% CI, 1.15-2.99; P = .01; and OR, 3.27; 95% CI, 1.96-5.45; P < .01; OR, 1.87; 95% CI, 1.14-3.07; P = .01; and OR, 1.81; 95% CI, 1.06-3.09; P = .03, respectively). There was no difference in infection rate or severe adverse events.CONCLUSIONS: Tofacitinib was associated with superior effectiveness outcomes compared with vedolizumab in anti-TNF-experienced patients with UC along with comparable safety outcomes.

引用

页码：182 / +

页数：12

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