Meta-Analysis: Improvement of Bowel Urgency With Advanced Therapies for Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) are chronic conditions that significantly affect quality of life. Bowel urgency, a particularly disruptive symptom of IBD, is often underreported in clinical trials.

To examine the effects of IBD therapies on bowel urgency (BU), focusing on the degree and durability of improvement.

We searched MEDLINE, Embase, and Cochrane databases in December 2024 for studies that reported a BU outcome for IBD therapies. We included only those studies that reported the absence of BU as a quantitative, binary outcome in the meta-analysis. We also performed a subgroup analysis by IBD subtype. We report risk ratios (RR) with 95% confidence intervals (CI).

We included 29 randomised controlled trials (RCTs) and 15 post hoc studies of RCTs representing eight therapeutic agents. There was significantly improved likelihood of BU remission across all induction (RR 1.77, CI 1.51-2.08) and maintenance (RR 2.40, CI 1.54-3.73) therapies compared to placebo, and no major differences between anti-interleukin-23 agents (risankizumab, mirikizumab, guselkumab) and a JAK-inhibitor (upadacitinib).

Advanced IBD therapies with different mechanisms of action produce rapid and sustained improvement in BU. The degree of BU improvement was similar among agents. Areas for future research include investigation of BU outcomes with other IBD therapies, exploration of underlying mechanisms of action, and greater standardisation for measuring BU through validated scores.