Alimentary Pharmacology & Therapeutics | 2021
Editorial: a long way to go before precision medicine
Abstract
While direct comparison is still lacking in the field of inflammatory bowel disease, network metaanalysis and realworld cohort studies are useful tool s to optimise daily use of biological agents. Among many burning questions, it is still debated whether ustekinumab or vedolizumab should be chosen as secondline biological therapy in patients with Crohn s disease. In this setting, Manlay et al performed a retrospective multicentre cohort comparative study of 312 patients, the largest to date, with Crohn s disease and prior exposure to antiTNF.1 To adjust for confounding factors, they applied propensity score matching. Similarly to previous published studies, they demonstrated a higher effectiveness of ustekinumab compared to vedolizumab.24 Moreover, they provided longterm analysis based on discontinuationfree survival, also in favour of ustekinumab. Although these data are useful in clinical practice, we are still feeling frustrated. Indeed, it is quite clear that ustekinumab is numerically and statistically superior to vedolizumab to induce and maintain steroidfree clinical remission in patients with Crohn s disease with prior exposure to antiTNF. However, the effectiveness of vedolizumab in the same setting is also quite clear (between 24.7% and 40.6% after 4854 weeks).14 Towards precision medicine, the real question would be to know to which patient should be offered either vedolizumab or ustekinumab with the best predictable results after antiTNF has failed. In the present study, a subgroup study was performed showing that ustekinumab was associated with higher steroidfree clinical remission rates than vedolizumab at Week 54 in patients older than 35 years, with no prior bowel resection, with upper GI involvement and without steroids at baseline.1 In a similar study, Alric et al showed different results as ustekinumab was associated with higher clinical remission rates than vedolizumab at Week 48 in patients older than 45 years, with prior bowel resection, history of perianal disease, penetrating behaviour and female gender.2 We look forward to further studies investigating predictors that could effectively assist clinicians for decisionmaking between vedolizumab and ustekinumab in this particular setting. ACKNOWLEDG EMENT Declaration of personal interests: Aurelien Amiot has received consulting fees from Abbvie, Hospira, Takeda, Gilead and Biocodex as well as lecture fees and travel accommodations from Abbvie, Janssen, Biocodex, Hospira, Ferring, Takeda and MSD. This author has also received advisory board fees from Gilead, Takeda and Abbvie.