Haynesworth Austin, Yeh Kuan-Hung, Lee Han Hee, Kirkpatrick Melissa, Boland Brigid S, Syal Gaurav, Xu Ronghui, Singh Siddharth
Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California, USA.
Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA.
Aliment Pharmacol Ther. 2025 Feb;61(4):693-701. doi: 10.1111/apt.18441. Epub 2024 Dec 11.
Although studies have compared on-treatment effectiveness of infliximab and vedolizumab in patients with ulcerative colitis (UC), there has been limited comparison of treatment sequencing and long-term patient-centred outcomes.
To compare infliximab-first and vedolizumab-first strategy in biologic-naïve patients with UC.
We conducted a retrospective cohort study in biologic-naïve patients with UC who were treated first with either infliximab or vedolizumab between 2015 and 2021 and followed over 30 months following initiation. Primary outcomes were the number of hospitalisations, corticosteroid courses and serious infections with either strategy (regardless of switch to alternative therapies) within 30 months. We matched the groups 1:1 through cardinality matching, and fit logistic and zero-inflated negative binomial models to compare outcomes.
We included 181 patients (94 vedolizumab-first and 87 infliximab-first treatment strategy). Of these, 144 were matched 1:1. There was no significant difference in the incidence of IBD-related hospitalisations (incidence rate ratio [IRR], 1.98 [95% CI, 0.64-6.10]), corticosteroid courses (0.66 [0.38-1.15]) and serious infections (5.26 [0.62-45.45]), with comparable incidence of medication switches to alternative advanced therapies (1.08 [0.42-2.81]). At 30 months, there was no difference in proportion of patients in clinical remission (69.4% vs. 76.4%; p = 0.45) and endoscopic remission (55.6% vs. 65.3%; p = 0.36).
In patients with UC, long-term effectiveness and safety outcomes are comparable with infliximab-first and vedolizumab-first treatment strategies at 30 months. This can help to guide selection of treatment strategies in patients with UC.
尽管已有研究比较了英夫利昔单抗和维多珠单抗对溃疡性结肠炎（UC）患者的治疗效果，但对于治疗顺序和以患者为中心的长期结局的比较却很有限。
比较在初治的UC患者中，先使用英夫利昔单抗和先使用维多珠单抗的治疗策略。
我们对2015年至2021年间初治的UC患者进行了一项回顾性队列研究，这些患者首先接受英夫利昔单抗或维多珠单抗治疗，并在开始治疗后随访30个月。主要结局是30个月内两种策略（无论是否改用其他疗法）的住院次数、使用皮质类固醇疗程和严重感染次数。我们通过基数匹配将两组按1:1进行匹配，并拟合逻辑回归模型和零膨胀负二项式模型以比较结局。
我们纳入了181例患者（94例先使用维多珠单抗和87例先使用英夫利昔单抗治疗策略）。其中，144例按1:1进行匹配。IBD相关住院发生率（发生率比[IRR]，1.98[95%CI，0.64 - 6.10]）、皮质类固醇疗程（0.66[0.38 - 1.15]）和严重感染（5.26[0.62 - 45.45]）无显著差异，改用其他先进疗法的药物转换发生率相当（1.08[0.42 - 2.81]）。在30个月时，临床缓解患者比例（69.4%对76.4%；p = 0.45）和内镜缓解患者比例（55.6%对65.3%；p = 0.36）无差异。
在UC患者中，30个月时先使用英夫利昔单抗和先使用维多珠单抗的治疗策略在长期有效性和安全性结局方面具有可比性。这有助于指导UC患者治疗策略的选择。
