Vedolizumab vs TNF Antagonists and Long-Term Outcomes in Ulcerative Colitis

What To Know

This Swedish nationwide cohort compared long-term outcomes for biologic‑naive patients with ulcerative colitis who started infliximab or adalimumab (TNF antagonists) versus vedolizumab as their first advanced therapy.

Patients were followed a median of about 4–5 years and outcomes included hospitalizations, colectomy, corticosteroid dispensations, therapy switching, and time spent in corticosteroid‑free disease stability. The study found no significant difference in all‑cause hospitalizations between vedolizumab and TNF antagonist initiators.

However, patients who started vedolizumab spent a larger proportion of follow‑up time in corticosteroid‑free disease stability and had lower rates of switching from initial advanced therapy compared with those who started a TNF antagonist.

These results come from linked national registers in Sweden and used inverse probability of treatment weighting and sensitivity propensity‑matched analyses to balance groups. The study reports associations rather than proving causation and reflects real‑world prescribing and outcomes during 2015–2023.

If you are choosing a first‑line biologic for ulcerative colitis, these findings suggest vedolizumab may be associated with more time off corticosteroids over several years compared with starting a TNF antagonist, but hospitalization risk appeared similar.