Short answer
For people choosing their first biologic for ulcerative colitis, two observational studies favour vedolizumab for some outcomes. They do not prove it is best for everyone or give someone doing well on infliximab a reason to switch.
This comparison should not guide urgent rescue treatment for acute severe colitis.
Acute severe colitis is a different situation
Someone with acute severe colitis needs urgent hospital assessment and treatment. If intravenous steroids have not worked, infliximab remains a rescue treatment supported by guidelines, alongside ciclosporin. These comparisons do not replace that urgent treatment pathway. See the AGA guidance on hospital treatment.
Watch Dr Pranab explain the comparison
In this short video, Dr Pranab Gyawali explains what the two studies add to the choice of a first biologic for ulcerative colitis.
What did the studies find?
A prospective study of 251 patients
He and colleagues followed people starting their first biologic. At one year, adjusted clinical remission was about 78% with vedolizumab versus 57% with infliximab. Treatment was not randomly assigned, so differences between the groups may still have influenced the result.
A larger Swedish study
Singh and colleagues studied 3,263 people starting infliximab, adalimumab or vedolizumab. Starting vedolizumab was associated with more time in steroid free disease stability than starting infliximab. Hospital admission and colectomy differences were not statistically significant. This assessed starting treatment strategies, including later changes in care.
Adverse effects: how did the two medicines compare?
The 251 patient study reported the following adverse event percentages during follow up:
| Vedolizumab | Infliximab |
|---|---|
| 5.5% | 7.6% |
The difference was not statistically significant. A smaller percentage here does not establish that vedolizumab is safer.
What about serious infections?
The Swedish study found no statistically significant adjusted difference in infections requiring hospital admission between the two starting strategies.
These studies measured different safety outcomes. Neither proves equal safety or rules out uncommon harms.
My clinical view
These studies help me discuss vedolizumab more clearly with my patients, especially when choosing their first biologic. However, in acute severe colitis needing urgent rescue treatment, infliximab has an established role supported by guidelines.
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Frequently asked questions
Should I change if infliximab is working?
These studies alone are not a reason to switch a treatment that is controlling your colitis. Discuss any change with your IBD team.
Do these results apply to Crohn’s disease?
No. These comparisons concern ulcerative colitis and should not be used to decide the treatment order for Crohn’s disease.
What if I have already tried a biologic?
These studies focus on the first biologic. Later treatment choices depend on what you have already used and why it did not work.
Related reading and VLOGs
Understanding UC treatment
Infliximab and vedolizumab
Other treatments and safety
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