Vedolizumab versus Adalimumab for Moderate-to-Severe Ulcerative Colitis: A Systematic Review of Head-to-Head Trials

Abstract

Introduction: For patients with ulcerative colitis (UC) refractory to conventional therapy, biologic options include the gut-selective anti-integrin agent vedolizumab and the systemic anti-TNF agent adalimumab. This review assesses their comparative efficacy based on head-to-head trial data.

Methods: We conducted a systematic review to identify head-to-head RCTs comparing vedolizumab and adalimumab in adult patients with moderate-to-severe UC. The primary endpoint was clinical remission at the end of the induction or maintenance phase.

Results: A single large, head-to-head RCT was identified. The trial demonstrated that vedolizumab was superior to adalimumab in achieving clinical remission and endoscopic improvement at week 52. The safety profile of vedolizumab was more favorable, with a lower rate of infections.

Discussion: The gut-selective mechanism of vedolizumab may offer a more targeted and safer approach for managing UC compared to the systemic immunosuppression of anti-TNF agents. This finding has significant implications for treatment sequencing in IBD.

Conclusion: Vedolizumab is superior to adalimumab for inducing clinical remission and endoscopic improvement in patients with moderate-to-severe ulcerative colitis.