RT Journal Article SR Electronic T1 Decreased risk of treatment failure with vedolizumab and thiopurines combined compared with vedolizumab monotherapy in Crohn’s disease JF Gut JO Gut FD BMJ Publishing Group Ltd and British Society of Gastroenterology SP 1781 OP 1789 DO 10.1136/gutjnl-2022-327002 VO 71 IS 9 A1 Julien Kirchgesner A1 Rishi J Desai A1 Maria C Schneeweiss A1 Laurent Beaugerie A1 Sebastian Schneeweiss A1 Seoyoung C Kim YR 2022 UL http://gut.bmj.com/content/71/9/1781.abstract AB Objective While infliximab combined to thiopurines is more effective than infliximab monotherapy in patients with Crohn’s disease (CD) and UC, the impact of adding thiopurines to vedolizumab remains controversial. We emulated two target trials comparing the effectiveness of combination therapy versus vedolizumab monotherapy in CD and UC.Design Based on two US and the French nationwide healthcare databases, patients with CD and UC who initiated vedolizumab were identified. The study methodology, including confounding adjustment and outcome definitions, were previously validated in successful emulations of the SONIC and SUCCESS trials. Risk ratios for treatment failure based on hospitalisation or surgery related to disease activity, treatment switch, or prolonged corticosteroids use, were estimated after 1:1 propensity score (PS) matching.Results Among a total of 10 299 vedolizumab users, 804 CD and 1088 UC pairs of combination therapy versus vedolizumab monotherapy users were PS matched. Treatment failure occurred at week 26 in 236 (29.3%) and 376 (34.3%) patients with CD and at week 16 in 236 (21.7%) and 263 (24.2%) patients with UC initiating combination therapy and vedolizumab monotherapy, respectively. The risk of treatment failure was decreased with combination therapy compared with vedolizumab monotherapy in CD (RR 0.85, 95% CI: 0.74 to 0.98) and to a lesser extent in UC (RR 0.90, 95% CI: 0.77 to 1.05). Findings were consistent across databases.Conclusion Using validated methodologies, combination therapy with vedolizumab and thiopurines was associated with lower treatment failure compared with vedolizumab monotherapy in CD but not UC across the USA and France.All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.