Comparison of clinical and endoscopic efficacy between vedolizumab and infliximab in bio-naïve patients with ulcerative colitis: a multicenter, real-world study

No head-to-head trial directly compares the effectiveness of vedolizumab (VDZ) and infliximab (IFX) in patients with ulcerative colitis (UC) who were naïve to biologic therapy. We aimed to compare the clinical and endoscopic effectiveness of VDZ and IFX in biologic-naïve patients with UC in real-world settings. It was a multicenter, observational, real-world cohort study conducted at five centers. Patients diagnosed with UC and treated with either IFX or VDZ as their first-line biologic therapy were retrospectively enrolled. Steroid-free remission, clinical response, clinical remission, and endoscopic healing at week 14 and week 52 were compared between the two groups after propensity score weighting. A total of 199 patients (117 VDZ and 82 IFX) were included in the study. There were no significant differences in steroid-free remission (64.6% vs 56.1%, = 0.224), clinical response (83.4% vs 73.4%, = 0.086), or clinical remission (69.4% vs 60.1%, = 0.174) at week 14. However, VDZ showed better results in steroid-free remission (67.5% vs 44.4%, = 0.004), clinical response (69.7% vs 47.1%, = 0.005), and clinical remission (67.5% vs 44.4%, = 0.004) at week 52. In terms of endoscopic healing, VDZ was similar to IFX at week 14 (25.7% vs 17.4%, = 0.185), but VDZ had a significantly higher rate at week 52 (29.5% vs 11.8%, = 0.027). VDZ was found to be superior to IFX in therapeutic continuation (hazard ratio = 0.339, 95% CI: 0.187-0.614,