Ustekinumab versus vedolizumab and ustekinumab versus tumor necrosis factor alpha agent infectious adverse effects in
Hussam Almasri1, Abdellatif Ismail2, Himsikhar Khataniar3
1Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
Introduction:
Ulcerative colitis (UC) often requires immunomodulatory therapies that balance efficacy with safety. Among biologics, vedolizumab and ustekinumab have emerged as alternatives to anti-tumor necrosis factor alpha (TNF-α) agents. We aim to address the incidence of specific infectious adverse events associated with these agents outside clinical trials using a real-world database.
Methods:
We conducted a retrospective cohort study using the TriNetX database. Three cohorts were defined as adult patients with UC, each treated with one of the following: ustekinumab, anti-TNFα agents, or vedolizumab. We used propensity score matching to balance groups. Outcomes included a new infection diagnosis.
Results:
Participants receiving ustekinumab demonstrated a significantly lower risk of several infections compared to those on anti-TNFα therapy, including pneumonia, urinary tract infection, cellulitis, Clostridioides difficile infection, infectious diarrhea, and sepsis. Compared to vedolizumab, ustekinumab was associated with a reduced risk of cellulitis and Clostridioides difficile infection.
Discussion:
Our findings demonstrate that ustekinumab is associated with a significantly lower risk of several infections. However, there is a less prominent difference in infectious risk when compared to vedolizumab. These results suggest that ustekinumab may offer a safer alternative, compared to anti-TNFα agents and possibly to vedolizumab, particularly those at higher risk of infections.
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