PT  - JOURNAL ARTICLE
AU  - Miller, Charles
AU  - Kwok, Hanson
AU  - Harrow, Paul
AU  - Vega, Roser
AU  - Seward, Edward
AU  - Mehta, Shameer
AU  - Rahman, Farooq
AU  - McCartney, Sara
AU  - Parisi, Ioanna
AU  - Lim, Samuel Hsiang
AU  - Sharma, Esha
AU  - Samaan, Mark A
AU  - Bancil, Aaron
AU  - Kok, Klaartje Bel
AU  - Shalabi, Ahmed
AU  - Johnston, Emma L
AU  - Katarey, Dev
AU  - Taherzadeh, Nina
AU  - Murray, Charles
AU  - Sharip, Mohammed Tauseef
AU  - Carter, Martyn J
AU  - Radhakrishnan, Shiva T
AU  - Peake, Simon
AU  - Khakoo, Imran
AU  - Wahed, Mahmood
AU  - Povlsen, Sebastian
AU  - Patel, Mehul
AU  - DuBois, Patrick
AU  - Finkel, Jemima
AU  - Onnie, Clive
AU  - Bloom, Stuart
TI  - Comparative effectiveness of a second-line biologic in patients with ulcerative colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab
AID  - 10.1136/flgastro-2021-101906
DP  - 2022 Sep 01
TA  - Frontline Gastroenterology
PG  - 392--401
VI  - 13
IP  - 5
4099  - http://fg.bmj.com/content/13/5/392.short
4100  - http://fg.bmj.com/content/13/5/392.full
SO  - Frontline Gastroenterol2022 Sep 01; 13
AB  - Background Sequential drug treatment with biological agents in ulcerative colitis (UC) is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second-line treatments. The study assesses whether using anti-tumour necrosis factor (anti-TNF)-α therapy following the α4β7 integrin blocker vedolizumab (VDZ) or VDZ after an anti-TNF has more favourable clinical outcomes in UC in a real-world outpatient setting.Methods Patients with UC who were exposed to first-line anti-TNF (adalimumab or infliximab) or VDZ who subsequently switched to the alternate class between May 2013 and August 2020 were identified by reviewing patient databases at 10 hospitals. Data were collected retrospectively using patient records. Baseline demographics, disease activity indices, biochemical markers, endoscopic Mayo score, colectomy rates, treatment persistence and urgent hospital utilisation composite endpoint (UHUC) rates were examined over a 52-week period.Results Second-line week 52 treatment persistence was higher in the VDZ group (71/81, 89%) versus the anti-TNF group (15/34, 44%; p=0.0001), as were week 52 colectomy-free survival (VDZ: 77/80, 96%, vs anti-TNF: 26/32, 81%; p=0.009), week 52 UHUC survival (VDZ: 68/84, 81%, vs anti-TNF: 20/34, 59%; p=0.002) and week 52 corticosteroid-free clinical remission (CFCR) rates (VDZ: 22/34, 65%, vs anti-TNF: 4/20, 20%; p=0.001).Conclusion Compared with second-line anti TNF usage, the VDZ second-line cohort had significantly higher 52-week treatment persistence, UHUC survival, higher colectomy-free survival rates and higher week 52 CFCR. These data suggest that VDZ is an effective biologic in UC as a second-line therapy after anti-TNF exposure. It highlights the effect of biological order on clinically important outcomes.Data are available upon reasonable request. Deidentified participant data are available on reasonable request. This can be requested by email to Dr Charles Miller (charles.miller@nhs.net)