Comparing real-world continuous clinical remission rates of anti-tumor necrosis factor, vedolizumab, ustekinumab, tofacitinib, and upadacitinib in ulcerative colitis
In brief
Ustekinumab led early-line remission; upadacitinib led after prior biologic use
In a 1,406-patient observational study, ustekinumab had the highest one-year continuous remission in patients new to advanced therapy, while upadacitinib performed best among those previously treated with biologics. Ustekinumab had the fewest adverse events; upadacitinib had the most, though few patients stopped it. Treatment choice still needs confirmation in comparative trials.
- Journal
- Inflammatory bowel diseases (Q1)
- Published
- 29 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Andrea Cassinotti, Simone Saibeni, Rosanna Cannatelli, Marco Michelon, Giovanni Maconi, Flavio Caprioli, et al.
- PMID
- 42955073
- DOI
- 10.1093/ibd/izag229
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 31 October 2026): Compares real-world effectiveness and safety of UC advanced therapies
Abstract
BACKGROUND: Multiple advanced therapies are available for moderate-to-severe ulcerative colitis (UC), but comparative efficacy data are limited. We compared the 1-year efficacy and safety of 7 therapies: the anti-tumor necrosis factor agents infliximab, adalimumab, and golimumab (GLM); the anti-integrin vedolizumab (VDZ); the anti-interleukin-12/23 ustekinumab (UST); and the JAK inhibitors tofacitinib (TOF) and upadacitinib (UPA). METHODS: In a retrospective, multicenter, propensity score-matched study, all UC patients treated with the 7 advanced therapies between 2014 and 2024 were included. The primary endpoint was the 1-year rate of continuous clinical remission (CCR) for each drug (defined as the induction and maintenance of steroid-free clinical remission, without the need for drug optimization or additional therapy due to relapse, with no adverse events requiring drug discontinuation). RESULTS: A total of 1406 patients were included (VDZ = 376, infliximab = 341, adalimumab = 207, UST = 150, GLM = 114, TOF = 103, UPA = 115). Excluding UPA from the overall population comparison as it was used only in bio-exposed patients, UST achieved the highest CCR, with GLM the lowest. UST appeared the most effective therapy in bio-naive patients, whereas other biologics achieved similar CCR rates. As second-line therapy, UPA achieved the highest CCR, followed by UST. As third-line therapy, UPA outperformed UST, VDZ, and TOF. UST was associated with the lowest rates of adverse events. Although UPA was associated with the highest rates of adverse events, drug withdrawal was low. CONCLUSIONS: In this large multicenter observational cohort, UST was more effective than anti-tumor necrosis factor agents and VDZ as both first- and second-line therapy. In bio-exposed patients, UPA was the most effective advanced therapy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.