The efficacy, safety, and persistence of vedolizumab versus adalimumab in patients with inflammatory bowel disease: a systematic review and meta-analysis.

Abstract

Purpose: This systematic review and meta-analysis compared the efficacy, safety, and treatment persistence of vedolizumab and adalimumab in patients with inflammatory bowel disease (IBD).

Methods: Through a comprehensive search of three databases up to September 2024, we calculated pooled effect estimates for binary outcomes using risk ratios (RR) with 95% confidence intervals (CIs). Heterogeneity was evaluated using Cochran's I² and Q statistics, with a random-effects model applied when I² exceeded 50%, and a fixed-effects model used otherwise. For randomized trials, the Cochrane Risk of Bias Tool was applied; the Newcastle-Ottawa Scale assessed nonrandomized trials.

Results: We analyzed 12 studies involving 4095 patients. The findings showed that vedolizumab had higher clinical remission and response rates compared to adalimumab (RR: 1.24, 95% CI 1.14-1.34, P < 0.01; RR: 1.11, 95% CI 1.01-1.22, P = 0.03). However, no significant differences were observed in endoscopic remission between the two treatments (RR: 0.74, 95% CI 0.47-1.18, P = 0.21). Safety outcomes, based on adverse and serious adverse event rates, have no significant differences (RR: 0.67, 95% CI 0.41-1.12, P = 0.13; RR: 0.78, 95% CI 0.36-1.68, P = 0.53). Treatment persistence also showed no significant difference between vedolizumab and adalimumab (RR: 0.78, 95% CI 0.55-1.12, P = 0.19).

Conclusions: Our study suggests that vedolizumab may be more effective than adalimumab in alleviating symptoms and achieving clinical response. Importantly, this effectiveness is achieved without an increase in adverse events. No significant difference was found in treatment persistence. However, high heterogeneity may weaken the evidence, requiring further randomized trials for confirmation.