Drug survival of anti‐TNF agents compared with vedolizumab as a second‐line biological treatment in inflammatory bowel disease: results from nationwide Swedish registers

BACKGROUND: Comparisons of second‐line anti‐tumour necrosis factor (TNF) agents and vedolizumab are sparse. AIM: To evaluate the effectiveness of anti‐TNF agents compared to vedolizumab as second‐line biologics in inflammatory bowel disease (IBD). METHODS: A propensity score‐matched cohort was created using Swedish nationwide registers. Patients with Crohn's disease or ulcerative colitis, exposed to first‐line anti‐TNF treatment, who initiated a second anti‐TNF agent or vedolizumab in 2014‐2016 (N = 1363) were included. The primary outcome was drug survival at 12 months. Secondarily, we assessed survival without IBD‐related hospitalisation, IBD‐related surgery, antibiotics, or hospitalisation because of infection, and also corticosteroid exposure. RESULTS: After 1:1 propensity score matching, 400 patients (Crohn's disease, N = 198; ulcerative colitis, N = 202) remained. For Crohn's disease, drug survival was 73% in the vedolizumab group vs 74% in the anti‐TNF group (difference: 1 percentage point; 95% confidence interval [CI]:‐11‐13; P = 0.87). Survival without IBD‐related hospitalisation (82% vs 88%), surgery (82% vs 89%), antibiotics (65% vs 71%), hospitalisation due to infection (95% vs 88%) and corticosteroids (58% vs 48%) were not statistically significantly different between groups. For ulcerative colitis, drug survival was 69% in the vedolizumab group vs 62% in the anti‐TNF group (difference: −7 percentage points; 95% CI: −20 to 6; P = 0.30). Vedolizumab‐treated patients had lower survival without IBD‐related hospitalisation (82% vs 93%, P = 0.02). Survival without colectomy (93% vs 97%), antibiotics (81% vs 70%), hospitalisation due to infection (92% vs 92%) and corticosteroids (58% vs 48%) were not statistically significantly different. CONCLUSIONS: Based on Swedish clinical practice, the effectiveness and safety of second‐line anti‐TNF and vedolizumab at 12 months appeared largely similar.