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Network Meta-Analysis: Efficacy of Biological Therapies and Small Molecules as Maintenance Therapy in Ulcerative

Brigida Barberio1, David J Gracie2,3, Christopher J Black2,3

  • 1Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.

Alimentary Pharmacology & Therapeutics
|May 23, 2025
PubMed
Abstract

Insights

Upadacitinib and etrasimod show consistent efficacy for ulcerative colitis (UC) maintenance therapy. This network meta-analysis highlights their effectiveness based on trial design, offering insights for treatment selection in UC patients.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Clinical Trials

Background:

  • Numerous biologics and small molecules are available for ulcerative colitis (UC) maintenance therapy.
  • Existing comparisons of treatment efficacy often overlook variations in randomized controlled trial (RCT) designs.

Purpose of the Study:

  • To conduct a network meta-analysis comparing the relative efficacy of biologics and small molecules for UC maintenance therapy.
  • To account for differences in trial design when evaluating treatment effectiveness.

Main Methods:

  • Literature search for RCTs up to February 27, 2025.
  • Efficacy assessed by clinical remission, endoscopic improvement, endoscopic remission, or corticosteroid-free remission.
  • Random effects model used with pooled relative risks (RR) and 95% confidence intervals (CI); drugs ranked by p-score.

Main Results:

  • Analysis included 28 RCTs (16 re-randomizing, 12 treat-through).
  • In re-randomized studies, upadacitinib ranked highest for clinical remission and endoscopic improvement.
  • In treat-through studies, etrasimod ranked highest for clinical remission, and infliximab for endoscopic improvement.

Conclusions:

  • Upadacitinib and etrasimod demonstrated consistent efficacy as maintenance therapies for ulcerative colitis (UC).
  • Findings provide valuable comparative efficacy data considering different trial designs for UC treatments.
Keywords:
RCT comparisondrugsefficacyulcerative colitis

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