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Comparative maintenance performance of all biologic agents and small molecules in ulcerative colitis: a network

Theodore Rokkas1,2, Javier P Gisbert3,4, Konstantinos Ekmektzoglou1,2

  • 1Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece.

European Journal of Gastroenterology & Hepatology
|March 13, 2024
PubMed
Abstract

Insights

This network meta-analysis compared maintenance treatments for moderate to severe ulcerative colitis (UC). Upadacitinib and etrasimod showed the best efficacy, while tofacitinib and infliximab offered the optimal efficacy-safety balance.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Clinical Medicine

Background:

  • Biologic agents and small molecules offer new options for moderate to severe ulcerative colitis (UC).
  • Comparative efficacy and safety of these maintenance treatments require further investigation.
  • Systematic review and network meta-analysis (NWM) are needed to consolidate evidence.

Purpose of the Study:

  • To conduct a systematic review and NWM.
  • To assess comparative efficacy and safety of treatments for moderate to severe UC maintenance.
  • To evaluate approved and emerging therapeutic options.

Main Methods:

  • Searched multiple databases (PubMed/Medline, EMBASE, Cochrane Library) through April 2023.
  • Primary endpoint: clinical remission at maintenance therapy end.
  • Bayesian NWM with Surfaces Under Cumulative Ranking (SUCRA) for efficacy and safety evaluation.

Main Results:

  • Included 20 RCTs with 7660 patients across 20 treatments.
  • Two study designs: re-randomization and treat-through.
  • Upadacitinib 30 mg/day (re-randomized) and etrasimod 2 mg/day (treat-through) ranked highest for efficacy.
  • Tofacitinib 10 mg (re-randomized) and infliximab 3.5 mg/Kg Q8W (treat-through) showed best efficacy-safety profiles.

Conclusions:

  • Upadacitinib and etrasimod are most effective for UC maintenance in re-randomized and treat-through designs, respectively.
  • Tofacitinib and infliximab provide the best efficacy-safety balance in their respective patient groups.
  • Findings guide treatment selection for moderate to severe UC maintenance.

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