TOPLINE:

In patients with ulcerative colitis (UC) exposed to anti-TNF therapy, tofacitinib was associated with higher rates of long-term clinical and steroid-free clinical remission than ustekinumab and vedolizumab. Endoscopic remission rates were higher in the vedolizumab group than in the ustekinumab group.

METHODOLOGY:

• Researchers in Italy conducted a multicentre retrospective observational study to compare the long-term efficacy and safety of tofacitinib, ustekinumab, and vedolizumab in 602 patients with UC who did not respond to or were intolerant to anti-TNF therapy and were prescribed a biologic or small molecular therapy.
• Vedolizumab was administered intravenously at 300 mg at weeks 0, 2, and 6 and then every 8 weeks (n = 260); ustekinumab was administered intravenously at 260, 390, or 520 mg on the basis of the patient's body weight, followed by 90 mg subcutaneously after 8 weeks (n = 193); and tofacitinib was administered orally at 10 mg twice daily for 8 weeks, followed by 5 mg twice daily (n = 149).
• An inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics across treatment groups.
• Primary outcomes were clinical remission (defined as a partial Mayo score ≤ 1) and steroid-free clinical remission assessed at weeks 12, 24, and 52; the safety profile was also evaluated by recording adverse events according to World Health Organization classification criteria.

TAKEAWAY:

• At 52 weeks, the tofacitinib group achieved significantly higher rates of clinical remission than the ustekinumab group (55.0% vs 41.0%; P < .001) and the vedolizumab group (55.0% vs 37.9%; P = .002).
• By 52 weeks, the tofacitinib group showed higher rates of steroid-free clinical remission than the vedolizumab group (53.0% vs 20.8%; P < .001), and the ustekinumab group demonstrated higher rates of steroid-free clinical remission than the vedolizumab group (41.0% vs 20.8%; P = .006).
• Rates of endoscopic remission (defined as a Mayo endoscopic score < 2) at 52 weeks were significantly higher in the vedolizumab group than in the ustekinumab group (27.9% vs 19.0%; P < .001).
• Adverse events were reported in 6.94% of patients in the tofacitinib group and 2.07% of those in the ustekinumab group. Serious adverse events occurred in 0.76% and 2.01% of those in the vedolizumab and tofacitinib group, respectively, with none reported in the ustekinumab group.

IN PRACTICE:

"Our findings indicate that tofacitinib provides the most durable clinical benefit, ustekinumab maintains intermediate effectiveness, and vedolizumab may be favored when mucosal healing is prioritized," the authors wrote.

SOURCE:

This study was led by Antonio Tursi, Territorial Gastroenterology Service, Barletta-Andria-Trani Local Health Agency, Andria, and Andrea Pasta, IRCCS Ospedale "San Martino" Hospital, Università di Genova, Genova, both in Italy. It was published online on June 15, 2026, in Therapeutic Advances in Gastroenterology.

LIMITATIONS:

The study was retrospective in nature and lacked data on some variables such as endoscopic parameters. Residual confounding cannot be ruled out despite the IPTW adjustment. Factors including the type of previous anti-TNF treatment failure, dependence on steroids, extraintestinal disease complications, and optimisation or increases in dosage may have affected treatment selection and the resulting outcomes.

DISCLOSURES:

This study did not receive any funding. Several authors declared serving as speakers and/or consultants and receiving advisory board fees, speaker fees, and research support from different pharmaceutical companies.

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