S1553 Ustekinumab Is Superior to Vedolizumab in Anti-TNF Naïve and Anti-TNF Exposed Patients With Crohn’s Disease: A Matched Cohort Study

Introduction: Ustekinumab and vedolizumab are commonly used in patients with moderate-to-severe Crohn’s disease. However, direct comparative studies evaluating their long-term efficacy, particularly in anti-tumor necrosis factor (TNF)-naïve and anti-TNF-exposed populations, remain limited. Methods: A retrospective cohort study utilizing the TriNetX U.S. Collaborative Network database was conducted to compare the real-world efficacy of Ustekinumab and vedolizumab in adult CD patients. Patients were stratified into anti-TNF-naïve and anti-TNF-exposed cohorts, and 1:1 propensity score matching (PSM) was employed. The primary outcome was the need for corticosteroid use at 12 and 24 months. Secondary outcomes included all-cause hospitalization rates, and emergency department (ED) visits. Results: In the anti-TNF-naïve cohort, ustekinumab was associated with significantly lower corticosteroid use at 12 months (29.3% vs 38.0%, P < 0.01) with HR of 0.69 (95% CI: 0.63–0.75) and 24 months (39.4% vs 45.6%, P < 0.01) with HR of 0.77 (95% CI: 0.71–0.83). Additionally, Ustekinumab-treated patients had fewer all-cause ED visits. No significant differences were observed in all-cause hospitalization rates. In the anti-TNF-exposed cohort, ustekinumab was similarly associated with reduced corticosteroid use at 12 months (39.3% vs 46.7%, P < 0.01) (HR: 0.76, 95% CI: 0.68–0.87) and 24 months (51.5% vs 55.0%, P < 0.01) (HR 0.83, 95% CI: 0.74–0.93). Ustekinumab-treated patients also demonstrated lower ED visit rates and reduced hospitalizations. Conclusion: Ustekinumab demonstrated superior corticosteroid-sparing effects and fewer healthcare utilization events compared to vedolizumab in both anti-TNF-naïve and anti-TNF-exposed CD patients. These findings suggest that ustekinumab may offer improved long-term disease control and reduced healthcare burden.