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Straatmijer T, Biemans VBC, Visschedijk M, Hoentjen F, de Vries A, van Bodegraven AA, Bodelier A, de Boer NKH, Dijkstra G, Festen N, Horjus C, Jansen JM, Jharap B, Mares W, van Schaik FDM, Ponsioen C, Romkens T, Srivastava N, van der Voorn MMPJA, West R, van der Woude J, Wolvers MDJ, Pierik M, van der Meulen-de Jong AE, Duijvestein M, van Workum M, de Jong D, van Dop W, van der Marel S, El Ghabzouri H, Talhaoui K, Oldenburg B, Boontje N, Fidder H, Hirdes M, Creemers RH, Hoekstra J, Smid J, Mujagic Z, François-Verweij M, Schakel- van den Berge T, Maljaars J, Theeuwen R, van den Berg D, Gerretsen S, Yocarini X, D’Haens G, Lowenberg M, Grootjans J, Gecse K, Bouma G, Waaijenberg P, Muskens B. Superior Effectiveness of Tofacitinib Compared to Vedolizumab in Anti-TNF-experienced Ulcerative Colitis Patients: A Nationwide Dutch Registry Study. Clin Gastroenterol Hepatol 2023; 21:182-191.e2. [PMID: 35644343 DOI: 10.1016/j.cgh.2022.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Clinicians face difficulty in when and in what order to position biologics and Janus kinase inhibitors in patients with anti-tumor necrosis factor-alpha (TNF) refractory ulcerative colitis (UC). We aimed to compare the effectiveness and safety of vedolizumab and tofacitinib in anti-TNF-exposed patients with UC in our prospective nationwide Initiative on Crohn and Colitis Registry. METHODS Patients with UC who failed anti-TNF treatment and initiated vedolizumab or tofacitinib treatment were identified in the Initiative on Crohn and Colitis Registry in the Netherlands. We selected patients with both clinical as well as biochemical or endoscopic disease activity at initiation of therapy. Patients previously treated with vedolizumab or tofacitinib were excluded. Corticosteroid-free clinical remission (Simple Clinical Colitis Activity Index ≤2), biochemical remission (C-reactive protein ≤5 mg/L or fecal calprotectin ≤250 μg/g), and safety outcomes were compared after 52 weeks of treatment. Inverse propensity score-weighted comparison was used to adjust for confounding and selection bias. RESULTS Overall, 83 vedolizumab- and 65 tofacitinib-treated patients were included. Propensity score-weighted analysis showed that tofacitinib-treated patients were more likely to achieve corticosteroid-free clinical remission and biochemical remission at weeks 12, 24, and 52 compared with vedolizumab-treated patients (odds ratio [OR], 6.33; 95% confidence interval [CI], 3.81-10.50; P < .01; OR, 3.02; 95% CI, 1.89-4.84; P < .01; and OR, 1.86; 95% CI, 1.15-2.99; P = .01; and OR, 3.27; 95% CI, 1.96-5.45; P < .01; OR, 1.87; 95% CI, 1.14-3.07; P = .01; and OR, 1.81; 95% CI, 1.06-3.09; P = .03, respectively). There was no difference in infection rate or severe adverse events. CONCLUSIONS Tofacitinib was associated with superior effectiveness outcomes compared with vedolizumab in anti-TNF-experienced patients with UC along with comparable safety outcomes.
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Affiliation(s)
- Tessa Straatmijer
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, the Netherlands; Leiden University Medical Centre, Department of Gastroenterology and Hepatology, Leiden, The Netherlands
| | | | - Marijn Visschedijk
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology, Radboud university medical centre, Nijmegen, The Netherlands; Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | | | - Adriaan A van Bodegraven
- Department of Gastroenterology, Geriatrics, Internal, and Intensive Care Medicine (COMIK), Zuyderland Medical Centre, Heerlen-Sittard-Geleen, The Netherlands
| | | | - Nanne K H de Boer
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
| | - Gerard Dijkstra
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Noortje Festen
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Bindia Jharap
- Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Wout Mares
- Ziekenhuis Geldersche Vallei, Ede, The Netherlands
| | | | - Cyriel Ponsioen
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, the Netherlands
| | | | | | | | - Rachel West
- Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | - Marije D J Wolvers
- Amsterdam UMC, department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Marieke Pierik
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Marjolijn Duijvestein
- Department of Gastroenterology, Radboud university medical centre, Nijmegen, The Netherlands.
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