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While vedolizumab (Entyvio) and the JAK inhibitor tofacitinib (Xeljanz) are both used to treat ulcerative colitis (UC) patients, their effectiveness and safety in anti-tumor necrosis factor (TNF)-exposed UC patients have not been extensively evaluated and compared.

In a study published in , patients in the Initiative on Crohn and Colitis (ICC) Registry who failed anti-TNF therapy and were started on vedolizumab or tofacitinib due to active clinical and biochemical or endoscopic disease were included. Corticosteroid-free clinical remission, biochemical remission, and safety were evaluated at 12, 24, and 52 weeks. A total of 83 vedolizumab and 65 tofacitinib patients were included in the study.

Tofacitinib patients were more likely to achieve corticosteroid-free clinical remission and biochemical remission at weeks 12, 24, and 52 compared with vedolizumab patients. Vedolizumab patients were more likely to discontinue therapy prior to 52 weeks, primarily due to non-response. There was no difference in the number of severe adverse events or infections between these two therapies.

Clinically, this study suggests that tofacitinib may be more effective in the treatment of anti-TNF-exposed UC patients compared with vedolizumab. This may help direct management after a patient fails anti-TNF therapy.

Wenly Ruan, MD, is a clinical instructor in the division of pediatric gastroenterology, hepatology, and nutrition at Baylor College of Medicine in Houston, Texas.

You can read an interview with the senior study author here, and the abstract of the study here.