For UC patients naïve to biologics, Remicade (infliximab) was shown to be superior in corticosteroid-free clinical remission, as well as endoscopic remission versus Entyvio (vedolizumab). This recent analysis found that clinical remission percentages were close at year one, with Remicade at 39.9% and Entyvio at 38.6%. Both of these are viable biologic options for the treatment of UC, and many people have had success with both. However, Remicade was found to have more patients with endoscopic remission at 36.0% and 25.6% respectively. As far as corticosteroid-free goes, Remicade won out here with 29.5%, whereas Entyvio saw 15.0%.
This analysis suggests that Entyvio may be equal in symptom control to Remicade. Nonetheless, Remicade remains the ‘gold standard’ for naive UC patients as it offers a higher chance of corticosteroid-free remission in addition to endoscopic remission. Entyvio did beat Remicade in one aspect. Those who took Entyvio had less chance of serious infection 5.3% vs 0.7%, although it was noted the rate of hospitalization was the same. It was found that Remicade may be a better choice for the ‘sicker’ patient, as the highest one-year success rates were those already on corticosteroids upon introduction of this biologic.
This large analysis included three major studies (ACT-1, Gemini-1, and VARSITY) that compared Remicade and Entyvio. A total of 795 naive UC patients participated in these three studies. Overall, by week 6 both Remicade and Entyvio showed promise with clinical responses at 60.5% and 60.0% respectively. Oftentimes patients are told that Entyvio often takes longer to start working, but these findings may debunk that. It was noted that Entyvio patients were more likely to be using combatant steroids and had higher albumin levels. In contrast, Remicade patients had more reports of pancolitis as well as higher rates of using immunomodulators. At 6 weeks clinical remission rates were at 39.9% and 38.6% respectively.
Primary outcomes were clinical remission at 52 weeks. This was defined as no more rectal bleeding and a Mayo clinic stool frequency sub-score normalization. Remicade and Entyvio are the preferred biologics for naive UC patients, and it’s easy to see why. Similar outcomes and assessment scores show that these biologics rank neck in neck. As with any study, there are a few limitations, including variations in endopic assessments as well as these studies being several years apart. As Remicade is an older biologic, its study was conducted in 2005. Entyvio is newer therefore its studies were conducted in 2014 and 2020.
Choosing to start a biologic to control UC symptoms is a big decision, and should be personalized to each patient and their individual needs. While both pose risks, they also both pose the ‘reward’ of remission. These biologics show promise in clinical response and clinical remission; however, they are different in how they work. Prescribing doctors should take into account previous biologic, corticosteroid, and steroid use as well as albumin levels. With the help of the results from this analysis, an educated decision can be made as to which choice is better for a particular patient. In the future after more studies on the subject are done, it may be common to see that Remicade is used as the introductory biologic and then the patient switched to Entyvio to maintain remission.
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