NEW YORK (Reuters Health) – For patients with Crohn’s disease, combining thiopurines with vedolizumab may be more effective than vedolizumab alone, new findings suggest.
“Infliximab combined with thiopurines is more effective than infliximab monotherapy in inflammatory bowel disease (IBD), but the impact of adding thiopurines to vedolizumab remains controversial. No clinical trials are currently performed to address this question,” researchers note in the journal Gut.
To investigate, they used two U.S. healthcare-claims database and the French nationwide healthcare database to identify nearly 10,300 patients with Crohn’s disease (CD) or ulcerative colitis (UC) who started vedolizumab therapy; 804 CD and 1,088 UC pairs of combination therapy versus vedolizumab monotherapy users were matched by propensity score.
Treatment failure (hospitalization or surgery due to disease activity, treatment switch, or prolonged corticosteroids use) was less common with combination therapy.
In patients with CD, treatment failure at 26 weeks occurred in 236 (29%) patients on combination therapy versus 376 (34%) on vedolizumab alone.
In patients with UC, treatment failure at 16 weeks occurred in 236 (22%) patients on combination therapy versus 263 (24%) on vedolizumab alone.
The risk of treatment failure was significantly lower with combination therapy compared with vedolizumab monotherapy in CD (relative risk, 0.85; 95% CI, 0.74 to 0.98) but not in UC (RR, 0.90; 95% CI, 0.77 to 1.05). The findings were consistent across the different databases.
“The present study is the first population-based study to provide head-to-head comparisons of vedolizumab and thiopurines combined versus vedolizumab monotherapy,” write Dr. Julien Kirchgesner of Brigham and Women’s Hospital, in Boston, and colleagues.
“These findings may help to guide treatment decisions in patients with IBD requiring vedolizumab,” they add.
The study had no commercial funding.
SOURCE: https://bit.ly/3uEUCrR Gut, online April 6, 2022.
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