Dai Jianfeng, Guo Rui, Gong Jing
Jianfeng Dai, College of Agroforestry and Health, The Open University of Sichuan, Chengdu, Sichuan Province 610073, P.R. China.
Rui Guo, Dept. of Gastroenterology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science & Technology of China, Chengdu, Sichuan Province 610072, P.R. China.
Pak J Med Sci. 2025 Jul;41(7):2110-2121. doi: 10.12669/pjms.41.7.12141.
To compare clinical efficiency of Ustekinumab (UST) and Vedolizumab (VDZ) in patients with Crohn's disease (CD), refractory to anti-tumour necrosis factor (anti-TNF) therapy.
PubMed, Web of Science, Scopus, and Embase databases were searched for studies published from inception until 15th May 2024. Cohort studies comparing UST and VDZ regimens in patients with refractory CD and reporting clinical, steroid-free, and biological remission, as well as providing data on treatment persistence were included. Random-effects models were used, and the meta-analyses results were presented as odds ratios (ORs) with 95% confidence intervals (CIs).
Sixteen included studies with 6584 patients were analysed. UST treatment regimen was linked to significantly higher clinical remission rates at 14-16 weeks (OR 1.41, 95% CI: 1.01, 1.98) but not at 52 weeks (OR 1.24, 95% CI: 0.85, 1.81) compared to VDZ. Patients receiving UST had higher steroid-free remission (SFR) rates in both induction (OR 1.33, 95% CI: 1.02, 1.73) and maintenance phases of the treatment (OR 1.56, 95% CI: 1.16, 2.08). However, biological remission rates during both induction and maintenance phases were comparable in the two groups. UST was associated with lower risk of all-cause hospitalization (OR 0.72, 95% CI: 0.59, 0.88) compared to VDZ.
UST is more efficient than VDZ in achieving rapid clinical remission and sustained steroid-free remission in CD patients who are refractory to anti-TNF therapy. While both regimens achieve long-term control of the disease with similar safety profiles, UST resulted in a lower risk of hospitalization. Further studies should confirm long-term outcomes and cost-effectiveness of these treatment plans.
比较优特克单抗（UST）和维多珠单抗（VDZ）在对抗肿瘤坏死因子（抗TNF）治疗难治的克罗恩病（CD）患者中的临床疗效。
检索PubMed、科学网、Scopus和Embase数据库中从数据库建立至2024年5月15日发表的研究。纳入比较难治性CD患者中UST和VDZ治疗方案并报告临床缓解、无类固醇缓解和生物学缓解情况，以及提供治疗持续时间数据的队列研究。采用随机效应模型，荟萃分析结果以比值比（OR）及95%置信区间（CI）表示。
分析了16项纳入研究中的6584例患者。与VDZ相比，UST治疗方案在14 - 16周时临床缓解率显著更高（OR 1.41，95% CI：1.01，1.98），但在52周时并非如此（OR 1.24，95% CI：0.85，1.81）。接受UST治疗的患者在治疗的诱导期（OR 1.33，95% CI：1.02，1.73）和维持期（OR 1.56，95% CI：1.16，2.08）无类固醇缓解（SFR）率均更高。然而，两组在诱导期和维持期的生物学缓解率相当。与VDZ相比，UST全因住院风险更低（OR 0.72，95% CI：0.59，0.88）。
在对抗TNF治疗难治的CD患者中，UST在实现快速临床缓解和持续无类固醇缓解方面比VDZ更有效。虽然两种治疗方案在疾病长期控制方面安全性相似，但UST导致的住院风险更低。进一步研究应证实这些治疗方案的长期疗效和成本效益。
