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Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis
TAKE-HOME MESSAGE
- This systematic review and network meta-analysis used data from randomized controlled trials to compare the efficacy of different advanced therapies in adults with moderate-to-severe ulcerative colitis. In clinical scenarios where Janus kinase inhibitors were available as first-line treatment, upadacitinib was the most effective in achieving clinical remission in biologic-naïve patients. Risankizumab and ozanimod ranked highest in achieving clinical remission in scenarios where Janus kinase inhibitors were not available as first-line treatment in biologic-naïve patients. In patients with prior biologic exposure, upadacitinib, tofacitinib, and ustekinumab ranked the highest for inducing remission.
- There are limited studies comparing the efficacy of advanced therapies in patients with IBD, which poses a challenge to providers when selecting advanced therapies. This network meta-analysis provides valuable information comparing the efficacy of available advanced therapies in patients with moderate-to-severe ulcerative colitis and can help guide treatment decisions.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND & AIMS
We performed an updated systematic review and network meta-analysis to inform the 2024 American Gastroenterological Association (AGA) Clinical Guidelines on the management of moderate-to-severe ulcerative colitis (UC).
METHODS
We searched multiple electronic databases through November 21, 2023, to identify randomized controlled trials in adults with moderate-to-severe UC, comparing different advanced therapies (tumor necrosis factor antagonists, vedolizumab, sphingosine-1-phosphate receptor modulators, interleukin 12/23 or selective interleukin 23 antagonists, and Janus kinase [JAK] inhibitors) against placebo or another active comparator. Our primary outcomes were induction and maintenance of clinical remission, and our secondary outcome was endoscopic improvement. We performed a network meta-analysis using a frequentist approach and applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to appraise certainty of evidence.
RESULTS
After excluding JAK inhibitors as potential first-line treatment (in accordance with the United States Food and Drug Administration), low-certainty evidence supports clinically important benefit with infliximab, ozanimod, risankizumab, and guselkumab over adalimumab and mirikizumab for achieving remission with induction therapy in biologically naïve patients with moderate-to-severe UC, with risankizumab and ozanimod being ranked the highest for induction of clinical remission. With the inclusion of JAK inhibitors as first-line therapy, upadacitinib was more efficacious compared with all other medications except ozanimod and risankizumab, with low- to moderate-certainty evidence. In patients with prior biologic exposure, upadacitinib, tofacitinib, and ustekinumab were ranked highest for achieving remission.
CONCLUSIONS
Using Grading of Recommendations, Assessment, Development and Evaluation to appraise quality of evidence, this updated network meta-analysis will be used to inform comparative efficacy and positioning of advanced therapies for the treatment of biologic-naïve and biologic-exposed patients with moderate-to-severe UC.
Additional Info
Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis
Gastroenterology 2024 Oct 18;[EPub Ahead of Print], AN Ananthakrishnan, MH Murad, FI Scott, M Agrawal, JP Haydek, BN Limketkai, EV Loftus, S SinghFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.