Tofacitinib, Vedolizumab Effective for UC Post-Anti-TNF Agent Failure

For patients with ulcerative colitis (UC) who fail to respond to anti-tumor necrosis factor (TNF) agents, tofacitinib and vedolizumab were found to be effective, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Patients with UC who had previously received a least 1 anti-TNF agent and were starting tofacitinib (n=87) or vedolizumab (n=112) between 2019 and 2021 at multiple sites in France were retrospectively evaluated for this study. The primary endpoint was corticosteroid-free clinical remission (CFREM), defined as partial Mayo score 2 or lower at week 16. The secondary endpoints were endoscopic improvement, defined as CFREM plus endoscopic Mayo score 1 or lower, and mucosal healing, defined as CFREM plus endoscopic and histological remission (Nancy index £1).

The tofacitinib vs vedolizumab patients were associated with longer disease duration (8.6 vs 7.4 years; P =.04), more had pancolitis (54.0% vs 38.4%; P =.028), had used 2 or more prior biologics (87.4% vs 37.5%; P <.001), and fewer used immunosuppressive therapies (4.6% vs 27.7%; P <.001).

At week 16, CFREM was achieved by 54.2% of tofacitinib and 42.5% of vedolizumab recipients (P =.089). Among the subset of patients with Mayo score 6 or higher, CFREM at 16 weeks was achieved among 57.4% and 51.1% (P =.77) after 1 biologic, 55.4% and 41.8% (P =.61) after 2 biologics, and 56.9% and 6.3% (P =.007) after 3 or more biologics for the tofacitinib and vedolizumab recipients, respectively. For patients who had experienced multiple biologic failures, tofacitinib was more effective at achieving CFREM (71.6% vs 30.8%; P =.049).

Among the subset of patients with endoscopy data (n=177), endoscopic improvement was higher among tofacitinib recipients (33.6% vs 7.1%; P =.048), and the rate of mucosal healing was similar between tofacitinib and vedolizumab recipients (6.4% vs 3.8%; P =.27), respectively. This study was limited by its small sample size and heterogenous population.

“Tofacitinib and vedolizumab are effective after failure to anti-TNF agents,” the study authors wrote. “Tofacitinib seems to be more effective in case of primary failure to biologics and multiple therapeutic failures.”

Reference

Buisson A, Nachury M, Fumery M, et al. Real-world multicenter comparison of effectiveness between tofacitinib and vedolizumab in patients with ulcerative colitis after failure to at least one anti-TNF agent. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract Su1503.

This article originally appeared on Gastroenterology Advisor