Prevalence of Immunomodulator Use as Combination Therapy With Vedolizumab or Ustekinumab in Inflammatory Bowel Disease.

Challenge

Immunomodulator combination therapy with vedolizumab and ustekinumab is common practice despite limited evidence supporting its benefit over monotherapy for these non-TNF biologics. The real-world prevalence of this practice and its clinical predictors had not been characterized in a large prospective IBD cohort.

Solution

The TARGET-IBD registry was analyzed to estimate the prevalence of immunomodulator combination therapy with vedolizumab and ustekinumab across 4,039 IBD patients, identifying clinical predictors of combination use and tracking how practice patterns have evolved over time since drug approval.

Impact

Documenting that combination therapy with vedolizumab and ustekinumab exceeds 30% despite limited evidence of benefit—and is driven by prior biologic exposure and perianal disease—provides prescribers and drug developers with real-world practice pattern benchmarks essential for designing combination therapy trials and safety monitoring programs.