Vedolizumab or infliximab: Treatment option in immune checkpoint inhibitor–induced colitis.

Abstract

2667 Background: ICI use is linked to severe gastrointestinal (GI) immune-related adverse events (irAEs), which affect morbidity and mortality and often require treatment pauses. Among these, immune-mediated colitis (IMC)—primarily associated with CTLA-4 therapy—occurs in 5.7% to 39.1% of patients receiving CTLA-4 inhibitors and 0.7% to 31.6% of those receiving PD-1/PD-L1 inhibitors; combination therapy can raise this incidence to 40.4%. IMC symptoms range from mild diarrhea to severe colitis, typically requiring urgent intervention within six to eight weeks of immunotherapy to prevent complications such as colonic perforation or sepsis. Corticosteroids are the usual first-line treatment, with TNF-alpha inhibitors (e.g., infliximab) considered when patients do not improve after three to seven days. Vedolizumab, a gut-selective α4β7 integrin antagonist that targets gastrointestinal-homing T-lymphocytes, offers an alternative approach. Both infliximab and vedolizumab—referred to as Selective Immunosuppressive Therapies (SITs)—have shown promise, though their distinct mechanisms have led to a lack of standardized protocols and reliance on provider discretion. This study compares infliximab, vedolizumab, and combined SITs (infliximab plus vedolizumab) in managing IMC, focusing on remission rates, recurrence, and improved steroid tapering success. Methods: A systematic search was conducted across the PubMed database. The Meta-Analysis was conducted using R version 4.4.1 to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of eight studies were included in the final analysis. In patients with immune checkpoint inhibitor–induced colitis, vedolizumab was associated with higher rates of colitis recurrence (OR = 0.32, 95% CI = 0.19–0.53) compared to infliximab. Patients receiving vedolizumab also had lower overall corticosteroid usage (mean difference in days: -18.29, 95% CI = -21.88 to -14.71) compared to infliximab recipients. There was no significant difference in remission rates between vedolizumab and infliximab monotherapy; however, higher remission was noted with combination therapy (vedolizumab plus infliximab) (OR = 0.40, 95% CI = 0.19–0.84) compared to infliximab monotherapy. Conclusions: Vedolizumab was associated with a higher recurrence rate of colitis but resulted in significantly lower corticosteroid usage compared with infliximab. Although remission rates were similar for both monotherapies, combination therapy (vedolizumab plus infliximab) demonstrated higher remission rates than infliximab alone.