Comparative Efficacy and Safety of Vedolizumab and IL-23 Inhibitors for IBD

Efficacy Comparison

The American Gastroenterological Association recommends vedolizumab as the preferred first-line biologic therapy for moderate-to-severe inflammatory bowel disease (IBD) due to its established long-term safety profile and strong evidence supporting its efficacy in both ulcerative colitis and Crohn's disease 1, 2, 3
Vedolizumab is recommended for induction and maintenance of remission in ulcerative colitis with strong evidence 2, 3
Long-term data shows that 83% of responders to vedolizumab remained in remission after 2 years and 89% after 3 years 4
Real-world effectiveness of vedolizumab is demonstrated in observational studies with steroid-free remission rates of 28.6-54% at one year 4
Vedolizumab is particularly effective in patients with Crohn's disease duration ≤2 years 4
Risankizumab and guselkumab are strongly recommended for moderate-to-severe ulcerative colitis 2
Mirikizumab is conditionally recommended for moderate-to-severe ulcerative colitis 2
Clinical remission rates with risankizumab in ulcerative colitis are 18.5% vs 6.2% for placebo 5
Clinical remission rates with mirikizumab in ulcerative colitis are 24.1% vs 11.8% for placebo 5
Risankizumab shows efficacy in Crohn's disease with clinical remission rates of 51.8% vs 39.6% for placebo at week 52 1

Vedolizumab has a lower risk of serious infections compared to TNF antagonists (32% reduction in ulcerative colitis patients) 3
IL-23 inhibitors are generally well-tolerated but have less long-term safety data compared to vedolizumab 5
Ustekinumab (IL-12/23 inhibitor) shows a 51% lower risk of serious infections compared to TNF antagonists in Crohn's disease 3

For patients with moderate-to-severe IBD, vedolizumab is preferred due to its established long-term safety profile and gut-selective mechanism 2, 3, 4
IL-23 inhibitors should be considered when patients have failed vedolizumab therapy or have extraintestinal manifestations that may benefit from systemic immunomodulation 2, 5

Vedolizumab remains effective in patients who have failed anti-TNF therapy, although response rates are somewhat lower compared to anti-TNF naïve patients 4
Vedolizumab shows higher response rates in Crohn's disease of ≤2 years duration 4
Subcutaneous vedolizumab is available as maintenance therapy with comparable efficacy to IV formulation, offering greater convenience 5