Biologics prevent infection-related hospitalization in IBD patients with comorbidity

Treatment with vedolizumab or ustekinumab leads to reduced rates of infection-related hospitalization compared with antitumour necrosis factor-α antagonists (anti-TNF) among adults with inflammatory bowel disease (IBD) initiating biologic therapy and with high comorbidity burden, reports a recent study.

A team of investigators assessed the comparative safety of biologic agents in older IBD patients with varying comorbidity burden (mean age 67 years) who were identified using data from a large, national commercial insurance plan in the US. These patients recently received treatment with anti-TNF, vedolizumab, or ustekinumab.

Comorbidity was defined using the Charlson Comorbidity Index (CCI). Infection-related hospitalization served as the primary outcome. The investigators used Cox proportional hazards models in propensity score-weighted cohorts to compare the risk of infections between these therapeutic classes.

The anti-TNF cohort included 2,369 patients, while that of vedolizumab and ustekinumab had 972 and 352 patients, respectively.

Patients on anti-TNF agents showed a similar rate of infection-related hospitalizations overall to those initiating vedolizumab (hazard ratio [HR], 0.94, 95 percent confidence interval [CI], 0.84‒1.04) and ustekinumab (HR, 0.92, 95 percent CI, 0.74‒1.16).

Among patients with a CCI >1, infection-related hospitalizations were significantly lower with ustekinumab (HR, 0.66, 95 percent CI, 0.46‒0.91; p<0.01 for interaction) and vedolizumab (HR, 0.78, 95 percent CI, 0.65‒0.94; p=0.02 for interaction) than with anti-TNFs.

Of note, no difference was observed among patients with CCI ≤1.