Ustekinumab and Anti-TNFs Show Comparable Efficacy After Vedolizumab Failure : GETAID | June 2026

Introduction:

Vedolizumab has become a widely used first-line advanced therapy for ulcerative colitis (UC) because of its favorable efficacy and safety profile. However, a substantial proportion of patients experience primary nonresponse or secondary loss of response, creating a growing need for evidence to guide treatment selection after vedolizumab failure. Despite the increasing use of vedolizumab as an initial biologic, data comparing subsequent therapeutic options remain limited.

Problem Statement:

The optimal second-line advanced therapy following vedolizumab failure is not well established. Clinicians frequently choose between anti-TNF agents and ustekinumab, but comparative real-world evidence regarding effectiveness, treatment durability, and safety is scarce. Identifying the most appropriate strategy is particularly important in patients with differing disease severity and risk profiles.

Summary:

This multicenter GETAID study evaluated real-world outcomes of infliximab, subcutaneous anti-TNF agents, and ustekinumab as second-line therapies after vedolizumab failure in patients with UC. The investigators found that all three treatment strategies achieved similar rates of steroid-free clinical remission and demonstrated comparable treatment persistence during follow-up. These findings suggest that both anti-TNF therapy and ustekinumab remain effective options after vedolizumab failure and support a flexible, individualized treatment approach. An important observation was that patients receiving corticosteroids at treatment initiation were less likely to achieve remission, highlighting baseline disease severity as a key determinant of outcome. While efficacy was broadly comparable across treatment groups, meaningful differences emerged in safety. Ustekinumab was associated with fewer adverse events and fewer treatment discontinuations related to toxicity, suggesting a more favorable tolerability profile. In contrast, infliximab remained an effective option, particularly for patients requiring rapid disease control in the setting of high inflammatory burden. These results provide valuable real-world guidance for treatment sequencing in UC and suggest that therapeutic selection after vedolizumab failure should be driven by individual patient characteristics, disease activity, comorbidity burden, and safety considerations. Overall, the study supports ustekinumab as an attractive option for patients in whom long-term safety is a major priority, while confirming that anti-TNF therapy remains a highly relevant and effective therapeutic strategy.