Effect of Biologic Therapies in Treating Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Biological therapies have emerged as effective treatments for moderate-to-severe ulcerative colitis (UC). This systematic review and meta-analysis aimed to assess the efficacy of different biologic agents for inducing clinical response, remission, and mucosal healing in patients with moderate-to-severe UC. A systematic literature search was conducted in PubMed, Excerpta Medica database (EMBASE), and Cochrane Library from inception to February 2025. Randomized controlled trials (RCTs) and prospective cohort studies evaluating biologics in adults with moderate-to-severe UC were included. The primary outcomes were clinical response, clinical remission, and mucosal healing. Random-effects meta-analyses were performed to calculate pooled effect estimates. Forty-three studies were included. Biologics were significantly more effective than placebo for inducing clinical response rates (odds ratio (OR): 2.19 (CI 95%: 2.66-3.19) p<0.00001, I²= 83%), remission rates (OR: 3.10 (CI 95%: 2.82-3.42) p<0.00001, I²= 92%), and mucosal healing (OR: 1.66 (CI 95%: 1.47-1.88) p<0.00001, I²= 85%) among UC patients. Heterogeneity was significant for most outcomes (I² > 50%). The quality of evidence ranged from low to moderate. Biologic therapies are effective for inducing response, remission, and mucosal healing in moderate-to-severe UC. Further high-quality studies are needed to directly compare different biologics and evaluate long-term outcomes.