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Comparative Efficacy of Biologics and Small Molecule in Ulcerative Colitis: A Systematic Review and Network

Mohammad Shehab1, Fatema Alrashed2, Abdulwahab Alsayegh3

  • 1Division of Gastroenterology, Department of Internal Medicine, Mubarak Alkabeer University Hospital, Kuwait; Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Jabriya, Kuwait.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|August 25, 2024
PubMed
Abstract

Insights

Upadacitinib shows superior efficacy for ulcerative colitis remission. Novel biologics like risankizumab and guselkumab also demonstrate high effectiveness in achieving clinical and histological remission.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Clinical Trials

Background:

  • Treatment options for moderate to severe ulcerative colitis (UC) are expanding.
  • Comparative efficacy data is lacking, posing a challenge for clinical decision-making.

Purpose of the Study:

  • To compare the relative efficacy of biologics and small molecules for achieving remission in moderate to severe UC patients.
  • To identify superior treatment options based on network meta-analysis.

Main Methods:

  • Systematic literature search up to May 2024 for Phase 3 randomized controlled trials.
  • Primary outcome: induction and maintenance of endoscopic improvement (MES ≤1).
  • Secondary outcomes: clinical, endoscopic (MES=0), and histological remission; sub-analyses by trial design and prior biologic exposure.

Main Results:

  • Upadacitinib ranked highest for inducing clinical remission (99.6%) and endoscopic improvement (99.2%).
  • Upadacitinib led in maintaining endoscopic improvement (98.6%) and histological remission (93.1%).
  • Risankizumab and guselkumab showed high efficacy in inducing and maintaining histological remission.

Conclusions:

  • Upadacitinib demonstrates superior efficacy in achieving clinical, endoscopic, and histological remission in UC.
  • Novel biologics (risankizumab, guselkumab) are effective alternatives.
  • Small molecules and selective IL-23 inhibitors represent promising therapeutic strategies.
Keywords:
BiologicsEfficacy of Endoscopic and Histological RemissionSmall MoleculesUC

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