INTRODUCTION We compared the efficacy of adalimumab, infliximab, ustekinumab, and vedolizumab on the ability to achieve endoscopic healing (EH) after 1 year of therapy in moderate-severe Crohn's disease (CD). METHODS This was a pooled analysis of patient-level data from 299 patients with CD from 4 clinical trials. Proportions of patients treated with each biologic were compared for achieving 1-year complete EH (Simple Endoscopic Score for CD [SES-CD] <3) and ileal and colonic EH separately (SES-CD = 0). Multivariate logistic regression was used to model the relationship between biologics and 1-year outcomes and adjusted for disease duration, concomitant corticosteroid use, and prior antitumor necrosis factor failure. RESULTS Compared with vedolizumab (4/56 [7.1%]), adalimumab (17/61 [27.9%], adjusted odds ratio [OR]: 5.79, 95% confidence interval [CI]: 1.77-18.95, P = 0.004) and infliximab (39/141 [27.7%], aOR: 4.59, 95% CI: 1.48-14.22, P = 0.008) had superior rates of 1-year EH. No significant difference was observed between vedolizumab and ustekinumab. Similar results were observed among biologic-naive patients. Among patients with baseline ileal SES-CD ≥3, no significant differences were observed between biologics for 1-year ileal EH. However, for large (>0.5 cm) ileal ulcers, infliximab (20/49 [40.8%]) had superior rates of no ileal ulcers compared with vedolizumab (2/23 [8.7%], aOR: 5.39, 95% CI: 1.03-28.05, P = 0.045). No other differences were observed. For colonic disease, compared with ustekinumab (9/31 [29.0%]), adalimumab (30/48 [62.5%], aOR: 3.97, 95% CI: 1.45-10.90, P = 0.007) had superior rates of 1-year EH in the colon, with similar trends observed for infliximab (55/105 [52.4%], aOR: 2.08, 95% CI: 0.82-5.27, P = 0.121). No other differences were observed. DISCUSSION In this post hoc analysis, TNF-α antagonists were overall superior to vedolizumab and ustekinumab for achieving 1-year EH in moderate-severe CD patients.

中文翻译：

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生物制剂对克罗恩病中回肠和结肠内镜愈合的比较疗效。

引言 我们比较了阿达木单抗、英夫利昔单抗、优特克单抗和维多珠单抗对中重度克罗恩病 (CD) 治疗 1 年后内镜下愈合 (EH) 能力的疗效。方法 这是对来自 4 项临床试验的 299 名 CD 患者的患者水平数据的汇总分析。分别比较了接受每种生物制剂治疗的患者比例，以实现 1 年完全 EH（CD 的简单内镜评分 [SES-CD] <3）和回肠和结肠 EH（SES-CD = 0）。多变量逻辑回归用于模拟生物制剂与 1 年结果之间的关系，并根据疾病持续时间、伴随的皮质类固醇使用和先前的抗肿瘤坏死因子失败进行了调整。结果 与维多珠单抗（4/56 [7.1%]）、阿达木单抗（17/61 [27.9%]）相比，调整优势比 [OR]：5.79，95% 置信区间 [CI]: 1.77-18.95, P = 0.004) 和英夫利昔单抗 (39/141 [27.7%], aOR: 4.59, 95% CI: 1.48-14.22, P = 0.008) 的 1 年率更高嗯。维多珠单抗和优特克单抗之间未观察到显着差异。在未使用生物制剂的患者中也观察到了类似的结果。在基线回肠 SES-CD ≥3 的患者中，1 年回肠 EH 的生物制剂之间未观察到显着差异。然而，对于较大的（>0.5 cm）回肠溃疡，英夫利昔单抗（20/49 [40.8%]）与维多珠单抗相比具有更高的无回肠溃疡发生率（2/23 [8.7%]，aOR：5.39，95% CI：1.03 -28.05，P = 0.045）。没有观察到其他差异。对于结肠疾病，与优特克单抗 (9/31 [29.0%]) 相比，阿达木单抗 (30/48 [62.5%], aOR: 3.97, 95% CI: 1.45-10.90, P = 0.007) 的 1 年发生率更高结肠中的 EH，英夫利昔单抗的趋势相似（55/105 [52.4%]，aOR：2.08，95% CI：0.82-5.27，P = 0.121）。没有观察到其他差异。讨论 在这项事后分析中，在中重度 CD 患者中，TNF-α 拮抗剂在实现 1 年 EH 方面总体上优于维多珠单抗和优特克单抗。