The following is a summary of “Risk of Gastrointestinal Infections After Initiating Vedolizumab and Anti-TNFα Agents for Ulcerative Colitis,” published in the August 2023 issue of the Clinical Gastroenterology by Dalal et al.

Characterise and compare the risk of Clostridioides difficile infection (CDI) and cytomegalovirus colitis (CMVC) following the initiation of vedolizumab or anti-tumor necrosis factor (TNF)α agents for the treatment of ulcerative colitis (UC). Immunosuppression is a known risk factor for gastrointestinal infections, such as Clostridium difficile infection (CDI) and cytomegalovirus colitis (CMVC), in patients with ulcerative colitis (UC). However, the specific risk associated with different biological classes is poorly comprehended. A retrospective cohort study was conducted at an extensive academic health system involving adults diagnosed with UC. The study focused on initiating vedolizumab or anti-TNFα agents between June 1, 2014, and December 31, 2020. The primary outcomes for Clostridium difficile infection (CDI) and cytomegalovirus colitis (CMVC) analyses were the occurrence of the first CDI or CMVC following the initiation of biological treatment. 

The secondary outcome for the Clostridium difficile infection (CDI) analysis was severe CDI, characterized by a white blood cell count greater than 10,000 or a serum creatinine level exceeding 1.5 mg/dL. The independent variables encompassed demographic characteristics and factors related to the history and severity of ulcerative colitis. Inverse probability of treatment weighted Cox regression was conducted to evaluate the risk of CDI based on the biological group. Due to a limited number of outcomes, the case of CMVC was reported descriptively. A total of 805 patients diagnosed with ulcerative colitis (UC) began treatment with vedolizumab (n=195) or anti-tumor necrosis factor alpha (anti-TNFα) agents (n=610). There were 43 cases of Clostridium difficile infections (CDIs) and 11 severe CDIs observed during 1,436 patient years. The Cox regression analysis, weighted by the inverse probability of treatment, revealed no evidence of a connection between Clostridium difficile infection (CDI) and vedolizumab compared to anti-TNFα therapy (hazard ratio 0.33, 95% CI 0.05-2.03).

However, it did find a significantly reduced risk of severe CDI for patients receiving vedolizumab compared to those receiving anti-TNFα treatment (hazard ratio 0.10, 95% confidence interval 0.01-0.76). Five cases of Cytomegalovirus Colitis (CMVC) were observed within the anti-tumor Necrosis Factor-alpha (anti-TNFα) cohort. There was a decreased adjusted risk of severe Clostridium difficile infection (CDI), but no significant impact on the overall occurrence of CDI was observed in association with vedolizumab. No Cytomegalovirus (CMVC) cases were detected following the initiation of vedolizumab treatment. These findings may offer reassurance regarding the utilization of vedolizumab while also considering the potential for gastrointestinal infections.

Source: journals.lww.com/jcge/Abstract/2023/08000/Risk_of_Gastrointestinal_Infections_After.10.aspx