Researchers sought to compare the incidence of Clostridioides difficile infection (CDI) and cytomegalovirus colitis (CMVC) in patients with ulcerative colitis (UC) receiving either vedolizumab or antitumor necrosis factor (TNF)α therapy. In the study, published in the Journal of Clinical Gastroenterology, the authors reported that vedolizumab was associated with a lower risk for severe CDI, but not total CDI, and no incidence of CMVC.

The retrospective study enrolled 805 patients with UC initiating vedolizumab (n=195) or anti-TNFα agents (n=610). The primary end point was the occurrence of primary CDI or CMVC after initiating treatment. Researchers also assessed severe CDI and variables, including demographics and disease history.

According to the report, there were 43 cases of CDI over 1436 patient-years. Eleven of those cases were classified as severe CDIs. Notably, the authors’ Cox regression models found no association between CDI and vedolizumab when compared with anti-TNFα agents (hazard ratio [HR], 0.33; 95% CI, 0.05-2.03); however, vedolizumab had a significantly lower risk for severe CDI (HR, 0.10; 95% CI, 0.01-0.76).

Additionally, 5 cases of CMVC were reported in the anti-TNFα group, while 0 were reported in the vedolizumab group. In closing, the authors stated their findings supported the use of vedolizumab even when accounting for gastrointestinal infection risk.

Reference: Dalal RS, Mitri J, Goodrick H, Allegretti JR. Risk of gastrointestinal infections after initiating vedolizumab and anti-TNFα agents for ulcerative colitis. J Clin Gastroenterol. 2022. doi:10.1097/MCG.0000000000001733