VEDOLIZUMAB was associated with greater long-term corticosteroid-free disease stability than tumour necrosis factor (TNF) antagonists in patients with ulcerative colitis (UC), according to a Swedish nationwide cohort study comparing first-line advanced therapies over 5 years. The findings highlighted potential differences in sustained disease control, although hospitalisation rates did not differ significantly between treatment groups.
Researchers analysed linked Swedish health register data from 3,263 biologic-naive patients with UC who initiated infliximab, adalimumab, or vedolizumab between January 2015 and June 2021. Patients were followed until June 2023, with median follow-up ranging from 4.3–5.4 years.
The study compared first-line treatment strategies using inverse probability of treatment weighting to account for differences in disease characteristics, healthcare utilisation, comorbidities, and medication use. The primary outcome was the incidence of all-cause hospitalisation, including recurrent events. Secondary outcomes included colectomy, corticosteroid dispensations, treatment switching, and time spent in corticosteroid-free disease stability.
This stability measure required patients to have no oral corticosteroid dispensations, initiation of a new advanced therapy or immunomodulator, hospitalisation, or colectomy during a 3-month period.
Hospitalisation rates did not differ significantly between patients initiating infliximab and those receiving vedolizumab (incidence rate ratio: 1.14; 95% confidence interval [CI]: 0.91–1.43). However, patients initiating infliximab spent a smaller proportion of follow-up quarters in corticosteroid-free disease stability than those receiving vedolizumab, at 60% versus 67% over 5 years (risk ratio: 0.88; 95% CI: 0.82–0.94).
Similar findings emerged from the comparison with adalimumab. Hospitalisation rates were not significantly different (incidence rate ratio: 1.08; 95% CI: 0.86–1.35), but adalimumab initiation was associated with more treatment switching (incidence rate ratio: 1.21; 95% CI: 1.02–1.43). Patients receiving adalimumab also spent less time in corticosteroid-free stability than those receiving vedolizumab, at 67% versus 70% of quarters (risk ratio: 0.92; 95% CI: 0.87–0.98).
The findings suggest that a vedolizumab-first strategy may offer advantages for long-term disease stability in biologic-naive patients with UC, despite no significant differences in hospitalisation burden. Results were broadly consistent in sensitivity analyses using one-to-one propensity score matching.
For clinicians selecting advanced therapies, these data provide comparative evidence on outcomes beyond hospitalisation, including corticosteroid exposure and treatment persistence. However, the observational design does not establish that vedolizumab directly causes better outcomes. The findings may help inform individualised first-line treatment decisions, with further consideration of patient characteristics and clinical circumstances remaining important.
Reference
Singh S et al. Vedolizumab vs TNF antagonists and long-term outcomes in ulcerative colitis. JAMA Netw Open. 2026;9(9):e2636165.
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