Results From Real-World Study Comparing Effectiveness and Positioning of Biologics in Inflammatory Bowel Disease Treatment

The tumor necrosis factor (TNF) inhibitor Remicade (infliximab) in 1998 became the first biologic approved to treat inflammatory bowel disease, including Crohn’s disease and ulcerative colitis (UC).

In the last two decades, several other advanced treatments and biologics have been approved to treat inflammatory bowel disease, including four biosimilars for Remicade.

In clinical guidelines, TNF inhibitors remain the preferred first-line advanced treatment for UC despite the emergence of new biologics approved for UC and Crohn’s disease. Head-to-head trials comparing the effectiveness of these treatments are scarce.

Christina Kapizioni from the departments of gastroenterology at Cambridge University Hospitals NHS Foundation Trust in the U.K. and Attikon University Hospital in Athens, Greece, and her colleagues conducted a large real-world study comparing the effectiveness of several biologic therapies and the impact of their treatment positioning (fist-line versus second-line, etc.) in patients with inflammatory bowel disease. The study results were published in the June 2024 issue of the Journal of Crohn’s and Colitis.

The researchers used data from the UK IBD BioResource and included 13,222 patients with inflammatory bowel disease who had used at least one biologic between January 2017 and January 2020. The included participants had obtained services from 106 different hospitals in the U.K. A total of 9,037 patients had Crohn’s disease, and 4,185 had UC.

Biologic therapies evaluated for UC included infliximab, adalimumab, golimumab, and vedolizumab. The study’s primary outcome was treatment effectiveness, based on persistence free of therapy discontinuation or treatment failure. The analysis consisted of over five years of follow-up.

The UC results showed that vedolizumab was more effective than TNF inhibitors as a first-line treatment. Additionally, after treatment failure from either therapy, vedolizumab was superior to infliximab and adalimumab.

The authors concluded that their study provides guidance for biologic selection in common scenarios in inflammatory bowel disease. They commented that their findings contest current clinical guidelines with regards to treatment selection after failure of the first TNF inhibitor.

Kapizioni and her colleagues wrote, “Given our evidence that [vedolizumab] outperformed both [infliximab] and [adalimumab] in first and second-line use in UC there is a case for positioning [vedolizumab] earlier in UC management, subject to appropriate health economic assessment.”

They added, “…in many healthcare systems, payers may dictate payment according to selection of drugs with lower acquisition costs. Where economic considerations position anti-TNF therapies first in UC, our data and those of others support second-line usage of [vedolizumab], regardless of mode of failure of anti-TNF.”