Vedolizumab versus Adalimumab for Moderate-to-Severe Ulcerative Colitis

To the Editor: In the randomized, head-to-head VARSITY trial comparing two biologic therapies that have different mechanisms of action (vedolizumab and adalimumab) in patients with ulcerative colitis, Sands et al. (Sept. 26 issue) 1 aim to fill a crucial knowledge gap: the comparative efficacy of treatments in ulcerative colitis. We have concerns about the generalizability of the results. First, regarding the suggested lower efficacy of adalimumab, patients who had not had a response to a tumor necrosis factor (TNF) inhibitor were eligible for inclusion, although guidelines recommend a shift out of class given the reduced efficacy of a second TNF inhibitor. 2 . . .