Ustekinumab versus vedolizumab in patients with Crohn's disease refractory to anti-tumour necrosis factor: A systematic review and meta-analysis.

Objective: To compare clinical efficiency of Ustekinumab (UST) and Vedolizumab (VDZ) in patients with Crohn's disease (CD), refractory to anti-tumour necrosis factor (anti-TNF) therapy. Methods: PubMed, Web of Science, Scopus, and Embase databases were searched for studies published from inception until 15th May 2024. Cohort studies comparing UST and VDZ regimens in patients with refractory CD and reporting clinical, steroid-free, and biological remission, as well as providing data on treatment persistence were included. Random-effects models were used, and the meta-analyses results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Sixteen included studies with 6584 patients were analysed. UST treatment regimen was linked to significantly higher clinical remission rates at 14-16 weeks (OR 1.41, 95% CI: 1.01, 1.98) but not at 52 weeks (OR 1.24, 95% CI: 0.85, 1.81) compared to VDZ. Patients receiving UST had higher steroid-free remission (SFR) rates in both induction (OR 1.33, 95% CI: 1.02, 1.73) and maintenance phases of the treatment (OR 1.56, 95% CI: 1.16, 2.08). However, biological remission rates during both induction and maintenance phases were comparable in the two groups. UST was associated with lower risk of all-cause hospitalization (OR 0.72, 95% CI: 0.59, 0.88) compared to VDZ. Conclusion: UST is more efficient than VDZ in achieving rapid clinical remission and sustained steroid-free remission in CD patients who are refractory to anti-TNF therapy. While both regimens achieve long-term control of the disease with similar safety profiles, UST resulted in a lower risk of hospitalization. Further studies should confirm long-term outcomes and cost-effectiveness of these treatment plans.