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Introduction

Vedolizumab (VED) and ustekinumab (UST) are valid options for ulcerative colitis (UC) and Crohn’s disease (CD) patients who fail anti-tumour necrosis factor (TNF) therapy. However, there are conflicting data on which drug should be preferred as second-line.

Aims & Methods

UC and CD patients who received VED or UST after anti-TNF failure or intolerance were included, and treatment groups were compared. The primary outcome of clinical remission (CR) was evaluated at 6 and 12 months of therapy, as were the secondary outcomes of corticosteroid-free CR and biochemical remission (BR). Endoscopic remission (ER) was evaluated at 12 months. Predictors of these outcomes were assessed using Cox regression.

Results

A total of 72 patients were included, 21 with UC (14 UST | 7 VED) and 51 with CD (35 UST | 16 VED). There were no significant differences in the various remission rates between both treatment groups, in UC and CD. In CD, multivariate analysis revealed baseline Harvey-Bradshaw index (HBI) as an independent predictor of failed CR (p<0.001, HR 1.42, IC 95% 1.18-1.71) and corticosteroid-free CR (p<0.001, HR 1.43, IC 95% 1.19-1.72) at 12 months. Anti-TNF discontinuation due to primary or secondary failure (vs. adverse event) was an independent predictor of BR at 12 months (p=0.028, HR 2.33, IC 95% 1.09-4.98). Interestingly, subanalysis of 16 patients who advanced to a third-line therapy with the opposite drug revealed a tendency for lower CR rates with VED (40.0%), when compared to UST (72.73%), albeit not statistically significant (p=0.299).

Conclusion

In this study, clinical, biochemical and endoscopic remission rates in UC and DC were not significantly different between patients treated with VED or UST as second-line therapy. HBI and reason for anti-TNF withdrawal were independent predictors of failed CR and BR, respectively. There may be a tendency for larger differences in CR when comparing VED and UST as third-line agents, with better results for the latter.

References

García MJ, Rivero M, Fernández-Clotet A, De Francisco R, Sicilia B, Mesonero F, et al. Comparative Study of the Effectiveness of Vedolizumab Versus Ustekinumab After Anti-TNF Failure in Crohn’s Disease (Versus-CD): Data from the ENEIDA Registry. Journal of Crohn’s and Colitis. 2024 Jan 27;18(1):65–74.
Onali S, Pugliese D, Caprioli FA, Orlando A, Biancone L, Nardone OM, et al. An Objective Comparison of Vedolizumab and Ustekinumab Effectiveness in Crohn’s Disease Patients’ Failure to TNF-Alpha Inhibitors. Am J Gastroenterol. 2022 Aug;117(8):1279–87.
Hyun HK, Zhang HS, Yu J, Kang EA, Park J, Park SJ, et al. Comparative effectiveness of second-line biological therapies for ulcerative colitis and Crohn’s disease in patients with prior failure of anti-tumour necrosis factor treatment. BMC Gastroenterol. 2022 Dec;22(1):143.
Singh, Amandeep MD; Khan, Freeha MD; Lopez, Rocio MS, MPH; Shen, Bo MD, FACG. Ustekinumab versus Vedolizumab for Moderate to Severe Crohn's Disease: 713. American Journal of Gastroenterology 112():p S393-S394, October 2017.

COMPARATIVE STUDY OF THE EFFICACY OF TWO BIOLOGIC THERAPY SEQUENCES IN INFLAMMATORY BOWEL DISEASE

José Damasceno 1, Bruno Arroja 1, Tania Carvalho 1, Andreia Guimarães 1, Joana Neves 1, Dalila Costa 1, João B. Soares 1, Raquel Gonçalves 1

1 Braga Hospital, Braga, Portugal

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Podcast Episode

UEG Podcast

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Transitional care with Patrizia Burra & Jorge Amil Dias

Patrizia Burra, Jorge Amil Dias, Pradeep Mundre

Topics

Paediatrics

Published

2025

UEG Mistakes In Articles

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Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Mistakes in ostomy management and how to avoid them

Revital Barkan, Ian White, Iris Dotan

Topics

Primary Care

Published

2025

UEG Mistakes In Articles

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Crohn’s disease (CD) is a chronic inflammatory bowel condition that can present with a wide range of intestinal and extra-intestinal manifestations. This condition can develop at any age and have a significant impact and impairment on quality of life for individuals including on relationships, educational attainment and work productivity. In particular, the time around and after diagnosis often involves the most upheaval for patients, and equally the biggest opportunity for effective intervention. Several recent advances have had a major impact on optimal management of patients with newly diagnosed CD. Here, we discuss the mistakes that are commonly made when managing patients presenting with a new diagnosis of CD. We summarise the evidence base and offer helpful and pragmatic tips for practising clinicians.

Mistakes in newly diagnosed Crohn's disease and how to avoid them

Joana Roseira, Nurulamin Noor

Topics

IBD

Citation

Roseira J and Noor N. Mistakes in newly diagnosed crohn's disease and how to avoid them. UEG Education 2025; 25: 18-23.

Published

2025

UEG Mistakes In Articles

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The complexity of managing inflammatory bowel disease (IBD) stems from the heterogeneity of Crohn’s disease and ulcerative colitis. This leads to differences in disease course, complications, and treatment responses among patients. Current treatment strategies rely on a trial-and-error approach, but there's a need for personalized therapy. Efforts have been made to develop reliable prognostic and predictive biomarkers to overcome disease heterogeneity. This article discusses common mistakes in biomarker development, interpretation, and application in IBD, emphasizing evidence-based insights and lessons learned from other fields.

Mistakes in biomarkers for IBD and how to avoid them

James C. Lee, Chris Palmer-Jones

Topics

IBD

Citation

: Palmer-Jones C. and Lee J. C. Mistakes in biomarkers for IBD and how to avoid them. UEG Education 2023; 23: 8-11.

Published

2023

UEG Mistakes In Articles

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Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

Topics

Primary Care

Published

2025

UEG Standards and Guidelines

Consensus

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Abstract

Background

The incidence and prevalence of inflammatory bowel disease [IBD] have increased significantly in low- and middle-income countries [LMICs] in recent decades. Managing IBD in these settings presents substantial challenges. This consensus aims to describe the epidemiology of IBD in LMICs and to highlight the key challenges in its diagnosis and treatment.

Method

The consensus-defining strategy followed the previous European Crohn’s and Colitis Organisation [ECCO] consensus guidelines [available at www.ecco-ibd.eu]. The authors reviewed the available evidence and formulated statements accordingly. Provisional ECCO statements and supporting text were drafted based on a comprehensive literature review and further refined through two voting rounds, which included external reviewers and national representatives from ECCO’s 36 member countries. The final ECCO statements, representing a consensus of at least 80% agreement among participants, were approved during an online meeting. Consensus statements should be interpreted in context with their accompanying commentary rather than in isolation and should not be used solely to guide patient management. The supporting text was finalized under the guidance of each working group leader [VP, HY, TK, AH] and subsequently integrated by the consensus leader [AE].

Results

Data on IBD epidemiology in LMICs remain limited. Public and healthcare professional awareness and timely access to early diagnostic modalities, advanced medical and surgical therapies, and specialist multidisciplinary care are key gaps in IBD care in LMICs. The complexity and chronic nature of IBD, along with the necessity for a multidisciplinary approach, pose significant challenges to adopting a holistic management strategy in LMICs.

Conclusion

There is a critical need for further studies to assess the specific needs of LMICs. Such research will help guide resource allocation and improve IBD management in these settings.

ECCO Consensus on management of Inflammatory Bowel Disease in low-and middle-income countries

Alaa El-Hussuna

Publisher

European Crohn’s and Colitis Organisation

Guideline

Consensus

Topics

IBD

Citation

Journal of Crohn's and Colitis; 2025

Published

2025

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