Comparative efficacy of pharmacologic interventions in ulcerative colitis: a network meta analysis

Area of Science:

• Gastroenterology
• Clinical Pharmacology
• Immunology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory colon condition requiring effective treatments.
• Numerous biologics and small molecules are available, but their comparative effectiveness is unclear.
• This study addresses the need for comparative data on UC therapies.

Purpose of the Study:

• To compare the effectiveness of current biologics and small molecules for UC.
• To evaluate induction and maintenance of remission in moderate-to-severe UC patients.
• To assess clinical response, endoscopic improvement, and steroid-free remission.

Main Methods:

• A network meta-analysis (NMA) of phase 2b/3 or 3 randomized controlled trials.
• Systematic literature search conducted up to February 21, 2025.
• Primary outcome: clinical remission (Full Mayo Score ≤ 2). Secondary outcomes: clinical response, endoscopic improvement, steroid-free remission.

Main Results:

• Upadacitinib demonstrated the highest likelihood for inducing clinical remission (99.08%), response (97.44%), and endoscopic improvement (99.32%).
• Upadacitinib also ranked highest for maintaining clinical remission (95.60%) and endoscopic improvement (99.46%).
• Tofacitinib showed the highest probability for steroid-free remission (92.43%).

Conclusions:

• Upadacitinib exhibits high efficacy in both induction and maintenance therapy for UC.
• Infliximab, guselkumab, and filgotinib are also effective, with tofacitinib leading in steroid-free remission.
• Small molecules and IL-23 inhibitors offer promising alternatives to older biologics, warranting further trials.