Real-world effectiveness of vedolizumab compared to anti-TNF agents in biologic-naive patients with ulcerative colitis: A two-year propensity-score-adjusted analysis from the prospective, observational VEDO_IBD-study

Background: This observational real-world evidence (RWE) study is based on prospectively collected data from the VEDOIBD registry study.Aim: To compare the effectiveness of vedolizumab and anti-TNF agents in biologic-naive patients with ulcerative colitis (UC) at the end of induction and during maintenance treatment.Methods: Between 2017 and 2020, we enrolled 512 patients with UC starting therapy with vedolizumab or an anti-TNF agent in 45 IBD centres across Germany. We excluded biologic-experienced patients and those with missing partial Mayo (pMayo) outcomes; this resulted in a final sample of 314 (182 on vedolizumab and 132 on an anti-TNF agent). The primary outcome was clinical remission measured using pMayo score; any switch to a different biologic agent was considered an outcome failure (modified ITT analysis). We used propensity score adjustment with inverse probability of treatment weighting to correct for confounding.Results: During induction therapy, clinical remission was relatively low and similar in vedolizumab- and anti-TNF-treated patients (23% vs. 30.4%, p = 0.204). However, clinical remission rates after two years were significantly higher for vedolizumab-treated patients than those treated with an anti-TNF agent (43.2% vs. 25.8%, p < 0.011). Among patients treated with vedolzumab, 29% switched to other biologics, versus 54% who had received an anti-TNF agent.Conclusion: After two years of treatment, vedolizumab resulted in higher remission rates than anti-TNF agents.