Tofacitinib Versus Vedolizumab Among Bio-naive Patients With Ulcerative Colitis: A Real-World Propensity-Weighted...

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Treatment options for moderate-to-severe ulcerative colitis (UC) have expanded.
• Comparative studies of advanced therapies, particularly in biologic-naïve patients, are limited.
• Tofacitinib and vedolizumab represent key advanced treatment options for UC.

Purpose of the Study:

• To compare the persistence, effectiveness, and safety of tofacitinib versus vedolizumab.
• To evaluate these agents as the first advanced therapy for ulcerative colitis.
• To provide data for informed clinical decision-making in UC management.

Main Methods:

• Retrospective cohort study of biologic-naïve UC patients in NHS Lothian.
• Inverse probability of treatment weighting (IPTW) was used for analysis.
• Key variables included age, sex, UC duration, disease extent, CRP, corticosteroid use, and partial Mayo score.

Main Results:

• Vedolizumab demonstrated superior persistence compared to tofacitinib at two years (p=0.005).
• Clinical, biochemical, and biomarker-based steroid-free remission rates were comparable between groups at weeks 12 and 52.
• Adverse event frequencies were similar, with primary non-response higher for tofacitinib and secondary loss of response higher for vedolizumab.

Conclusions:

• Vedolizumab exhibited superior persistence and tolerability over tofacitinib in biologic-naïve UC patients.
• Effectiveness, measured by clinical and biomarker remission, was comparable between the two agents.
• These findings can guide the optimal positioning of advanced therapies in UC treatment algorithms.