A previous blog post (Vedolizumab More Effective Than Adalimumb for Ulcerative Colitis) highlighted a preliminary report on the “VARSITY” study. The full report has now been published (BE Sands et al NEJM 2019; 381: 1215-26) and a little nuance is needed.

This double-blind, double-dummy randomized trial included 769 patients who underwent randomization to receive at least one dose of one of the study medications.

Key findings:

• At week 52, clinical remission was higher in the vedolizumab group: 31.3% compared to 22.5% for adalimumab
• Endoscopic improvement was better for vedolizumab: 39.7% compared to 27.7%
• Corticosteroid-free remission was better for adalimumab: 21.8% compared to 12.6% for vedolizumab

Limitations:

• dose escalation was not allowed during the study –this limitation likely favors vedolizumab compared to adalimumab
• previous exposure to an anti-TNF agent was allowed in up to 25% of patients

My take:  In two of three key measures, vedolizumab outperformed adalimumab.  This study provides a rationale for vedolizumab to be considered a first-line agent.  That being said, in my clinical experience, infliximab is a much more frequently used anti-TNF agent in moderate-to-severe ulcerative colitis.  So a head-to-head study with infliximab would be of interest.

The image below shows histologic remission differences at week 52

Related posts:

• Vedolizumab vs. Adalimumab for Infliximab Failure in Ulcerative Colitis: Which is better?
• Getting the Most Out of Vedolizumab
• Enthusiasm for Vedolizumab