Comorbidities flag poor outcome on vedolizumab, ustekinumab for IBD

In the treatment of patients with inflammatory bowel disease (IBD), comorbidities, but not patient age, influence the risk of any infection or hospitalizations on either vedolizumab or ustekinumab, a study suggests.

The analysis included 203 vedolizumab‐treated and 207 ustekinumab‐treated IBD patients. A total of 95 patients had one or more comorbidities (Charlson Comorbidity Index [CCI]; 49 and 46 in the respective groups). Sixty-three patients (15.4 percent) were aged ≥60 years, 140 (34.1 percent) between 40 and 60 years, and 206 (50.2 percent) <40 years. Of those in the oldest age group, 36 patients were treated with vedolizumab and 27 with ustekinumab.

Median treatment duration was 54.0 weeks with vedolizumab and 48.4 weeks with ustekinumab, with median follow‐up time of 104.0 and 52.0 weeks, respectively.

Multivariable logistic regression showed that CCI was significantly associated with the likelihood of any infection (odds ratio [OR], 1.387, 95 percent confidence interval [CI], 1.022–1.883; p=0.036) and hospitalization (OR, 1.586, 95 percent CI, 1.127–2.231; p=0.008) in the vedolizumab group, and also with hospitalization (OR, 1.621, 95 percent CI, 1.034–2.541; p=0.035) in the ustekinumab group.

CCI did not influence treatment efficacy. On the other hand, age was not associated with any outcomes.

The present data indicate that while the efficacy of both drugs is not impaired by the presence of comorbidities or a higher age, comorbidity status assessment should be performed to patients initiating vedolizumab or ustekinumab therapy in order to discuss additional safety risks, according to the researchers.