TOPLINE:

Among patients with ulcerative colitis (UC) after vedolizumab failure, infliximab, subcutaneous anti-TNF agents, and ustekinumab demonstrated comparable effectiveness and treatment persistence as second-line therapies.

METHODOLOGY:

• Researchers conducted a retrospective cohort study across 31 GETAID centres in France and Belgium, including 196 patients with UC (median age, 46.6 years; 52% women) who received infliximab (n = 99), subcutaneous anti-TNF agents (n = 27), or ustekinumab (n = 70) after vedolizumab failure between March 2016 and June 2024, with a follow-up duration of at least 14 weeks.
• The primary endpoint was steroid-free clinical remission (SFCR) — defined by a partial Mayo Clinic score ≤ 2, no subscore > 1, and no treatment discontinuation — at week 14.
• Secondary outcomes included remission and response at weeks 14 and 52, drug persistence, adverse events, and hospitalisation.
• Serious adverse events were identified as those resulting in death, life-threatening conditions, hospitalisation, significant disability, congenital anomaly, or treatment discontinuation.

TAKEAWAY:

• At week 14, 39.8% patients achieved SFCR — 38.4% with infliximab, 29.6% with subcutaneous anti-TNF agents, and 45.7% with ustekinumab — with no statistically significant differences between the groups.
• Median treatment persistence ranged from 8.0 to 9.2 months, with no statistically significant differences between the groups.
• Treatment discontinuation due to adverse events occurred in 12.1% of patients who received infliximab, 14.8% of those who received subcutaneous anti-TNF agents, and 2.9% of those who received ustekinumab, with significantly lower rates for ustekinumab than for infliximab (P = .045) and subcutaneous anti-TNF agents (P = .049).
• Hospitalisations for UC flares were significantly fewer with ustekinumab than with infliximab (8.6% vs 22.2%; P = .02). Serious adverse event rates were comparable across groups: 16.1% for infliximab, 14.8% for subcutaneous anti-TNF agents, and 5.7% for ustekinumab.

IN PRACTICE:

"From a clinical perspective, our findings suggest that selection of a second‐line advanced therapy after vedolizumab in UC should primarily rely on individual patient characteristics rather than on an assumed hierarchy of efficacy between biologics. Factors such as disease severity, inflammatory burden, comorbidities, prior safety profile, and patient preference are likely to play a central role," the authors of the study wrote.

SOURCE:

This study was led by Louis Calméjane, Université Paris Cité, Paris, France. It was published online on March 25, 2026, in United European Gastroenterology Journal.

LIMITATIONS:

The study was limited by its retrospective design, which may have resulted in missing data for key variables. Reimbursement restrictions may have led to the exclusion of several second‑line options (JAK inhibitors, S1P modulators, and anti‑interleukin‑23 p19 agents), and dose optimization strategies were not captured.

DISCLOSURES:

This study did not receive any funding. Several authors reported receiving lecture, consulting, or board fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.