Systematic review with meta-analysis: the effectiveness of either ustekinumab or vedolizumab in patients with Crohn's disease refractory to anti-tumour necrosis factor

Background Ustekinumab and vedolizumab are commonly used after anti-tumour necrosis factor (TNF) failure in patients with Crohn's disease (CD). No randomised controlled trial has compared these drugs. Aims To compare the effectiveness of ustekinumab and vedolizumab in CD patients refractory to anti-TNF. Methods From PubMed, EMBASE and the Cochrane Library, through March 27, 2021, we identified studies that compared ustekinumab and vedolizumab in patients with CD refractory to anti-TNF. The main outcomes were clinical remission and steroid-free clinical remission at weeks 14 and 52. Secondary outcomes were biological remission and treatment persistence. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) using random effects meta-analysis. Results We identified 1513 reports. Among them, 38 studies were assessed for eligibility and five studies were included. All studies included were of high quality: four were retrospective and one was prospective. Among 1026 patients, 659 received ustekinumab and 367 received vedolizumab. At week 14, clinical remission (OR 1.36; 95%CI: 0.74-2.47; I-2 = 50%), steroid-free clinical remission (OR 1.24; 95%CI: 0.79-1.92; I-2 = 52%) and biological remission (OR 0.80; 95%CI: 0.50-1.28; I-2 = 0%) rates were similar between the two treatments. At week 52, ustekinumab was associated with higher rates of clinical remission (OR 1.87; 95% CI: 1.18-2.98; I-2 = 0%), steroid-free clinical remission (OR 1.56; 95% CI: 1.23-1.97; I-2 = 0%), biological remission (OR 1.86; 95% CI: 1.03-3.37; I-2 = 29%) and treatment persistence (OR 2.37; 95% CI: 1.56-3.62; I-2 = 0%). Conclusion In patients with CD refractory to anti-TNF, ustekinumab and vedolizumab are similarly effective in induction, but as maintenance treatment, ustekinumab appears to be more effective than vedolizumab.