Subcutaneous infliximab versus subcutaneous vedolizumab in IBD

Subcutaneous infliximab therapy outperformed subcutaneous vedolizumab therapy in participants with Crohn’s disease (CD), according to a comparative analysis. In participants with ulcerative colitis (UC), the 2 therapies appeared to be equally efficacious. The safety profiles of subcutaneous infliximab and vedolizumab therapies were comparable over 1 year of follow-up in both CD and UC.

Prof. Laurent Peyrin-Biroulet (Nancy University Hospital, France) compared the efficacy of subcutaneous infliximab and subcutaneous vedolizumab induction and maintenance therapies in participants with CD and UC, using data from 7 randomised-controlled trials [1]. The infliximab subcutaneous trial (NCT02883452) was compared with trials on vedolizumab including GEMINI II, GEMINI III, and VISIBLE 2 for CD and GEMINI I, VISIBLE 1, and VARSITY for UC.

In participants with CD, subcutaneous infliximab induction therapy was superior to subcutaneous vedolizumab induction therapy (all non-overlapping 95% CI intervals) with regard to Crohn's Disease Activity Index (CDAI)-70 response (79% [95% CI 0.66-0.88] vs 45% [0.32-0.60]), CDAI-100 response (62% [0.49-0.74] vs 36% [0.29-0.44]), clinical remission^a rate (49% [0.36-0.62] vs 17% [0.12-0.24]), and discontinuations due to lack of efficacy (5% [0.01-0.28] vs 32% [0.26-0.39]). Moreover, subcutaneous infliximab maintenance therapy displayed higher CDA-100 response (64% [0.51-0.76] vs 47% [0.33-0.62]) and clinical remission rates (57% [0.43-0.69] vs 42% [0.31-0.54]) than subcutaneous vedolizumab maintenance therapy in participants with CD. In participants with UC, the therapies appeared to be equally efficacious. The safety profiles of the 2 therapies were comparable.

Prof. Peyrin-Biroulet added that not all participants in the vedolizumab trials were biologic-naïve. “Since we know that previous exposure to a TNF inhibitor may reduce the efficacy of vedolizumab, a subgroup analysis needs to be performed to compare the efficacy of subcutaneous infliximab and vedolizumab therapies in biologic-naïve and biologic-experienced patients.”

a. Clinical remission is defined as an absolute CDAI score <150 points.

1. Peyrin-Biroulet L, et al. A comparative efficacy and safety analysis of subcutaneous infliximab and vedolizumab in patients with Crohn’s Disease and Ulcerative Colitis. DOP73, ECCO 2022, 16–19 February.

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Posted on 12 April, 2022