Ozanimod and Vedolizumab as First-Line Advanced Therapies in Ulcerative Colitis

To the Editors:

We hereby comment on Kochhar et al’s recent publication, “Comparative Effectiveness of Ozanimod and Vedolizumab as First-Line Advanced Therapies in Ulcerative Colitis: A Propensity-Matched Cohort Analysis.”¹ This retrospective cohort research study comparing ozanimod with vedolizumab in persons with ulcerative colitis (UC) reveals important information about the efficacy of ozanimod and vedolizumab. Although the use of a large, multi-institutional database, TriNetX, improves the study’s external validity, numerous methodological difficulties should be addressed. For example, a large difference in cohort size (222 patients receiving ozanimod vs 4145 patients receiving vedolizumab) may introduce bias; a small cohort may lack sufficient statistical power to detect significant differences, particularly when considering the composite outcome measure; and the small number of events may reduce the significance of the findings.

In addition, this study used propensity score matching, which is an efficient strategy for controlling for confounding variables. However, because it is retrospective, it has a limited ability to capture all significant aspects that may influence treatment results, such as patient adherence, treatment length, and the presence of unmeasured confounders. Furthermore, because a composite measure does not capture the level of patient response to treatment, focusing on the composite result may mask specific patient experiences.

To broaden the conversation, we suggest that researchers explore the clinical implications of these findings. Given the significant probability of therapy change in the ozanimod group, what implications does this have for the long-term management of UC? When deciding on these therapies, consider the patient’s preferences and quality of life. Questions have the potential to help doctors understand the real-world relevance of various therapeutic alternatives and influence decision making.

Future research avenues could involve more complex techniques for analyzing treatment results, stratifying outcomes based on other criteria such as illness severity, patient demographics, prior treatment history, and gender. Future randomized controlled studies may give more firm information on the efficacy and safety of ozanimod and vedolizumab. Furthermore, including patient-reported outcomes and real-world adherence data will help us better understand how treatment affects everyday living and overall patient satisfaction. Finally, research into potential biomarkers for predicting treatment response could lead to individualized treatment approaches, optimization of treatment options based on individual features, and improved outcomes in the management of UC by gender.

Acknowledgments

The authors a used language editing computational tool in preparation of the article.

Author Contribution

H.P.: 50% ideas, writing, analyzing, approval. V.W.: 50% ideas, supervision, approval. All listed authors have contributed to the manuscript substantially and have agreed to the final submitted version.

Funding

None.

Conflicts of Interest

The authors declare no conflict of interest.

Data Availability

There are no new data.

Reference