Comparative Efficacy and Safety of Adalimumab vs Vedolizumab in Managing Moderate-to-Severe Crohn's Disease: A Systematic Review and Meta-Analysis

Introduction: Crohn's disease (CD) continues to pose a substantial health issue, perplexing patients and healthcare professionals because of its erratic progression and inconsistent reaction to treatment. Biological drugs like Adalimumab (ADA) and Vedolizumab (VDZ) have become increasingly popular due to their potential efficacy in treating moderate to severe cases of the disease. Nonetheless, the data comparing these 2 treatments can often be diverse and occasionally contradictory. Methods: A systematic search was conducted on PubMed, Medline, Web of Science, Scopus, the Cochrane Library, Embase, Google Scholar, CINAHL, Clinicaltrials.gov, and WHO trials registry (ICTRP) from database inception until April 2023 to look for potentially eligible articles. The reference lists of eligible studies and review articles were also checked manually to identify other relevant publications. All retrieval processes were performed independently by 2 researchers. Results: The forest plot analysis showed a significantly beneficial effect of ADA and VDZ for induction of remission with superiority of ADA over VDZ among CD patients: OR= 3,037, P = 0,000 and OR= 2,444, P = 0,000, respectively. Also, there was a significant beneficial effect of ADA and VDZ for induction of response with a slight superiority of ADA over VDZ among CD patients: OR= 2,601, P = 0,000 and OR= 2,254, P = 0,000, respectively. Regarding maintenance therapy, our meta-analysis showed that ADA (OR=4,808, P = 0,000) and VDZ (OR=2,014, P = 0,000) were superior to the placebo in remission rates with superiority of ADA over VDZ. Similarly, both ADA (OR=4,330, P = 0,000) and VDZ (OR=1,581, P = 0,004) were superior to the placebo in response rates, with superiority of ADA over VDZ among CD patients. Regarding the serious adverse events, placebo presented more serious adverse events than ADA among CD patients (OR=0,514, P = 0,000). However, no significant difference was detected between VDZ and placebo (OR=1,284, P = 0,076) (Figure 1). Conclusion: Systematic investigation, through systematic review and meta-analysis, is paramount in healthcare. Specifically, comparing the efficacy and safety of Adalimumab and Vedolizumab in Crohn's disease management aids in refining treatment strategies, ensuring patient safety, and guiding future research, ultimately contributing to better patient care and improved health outcomes.Figure 1.: Forest plot showing the effects of (A) ADA and (B) VDZ on CD.