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

IF 4.6 2区医学 Q2 IMMUNOLOGY

Inflammopharmacology Pub Date : 2025-03-29 DOI:10.1007/s10787-025-01723-z

Atta Ullah Khan, Maria Ali, Muhammad Aamir Wahab

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引用次数: 0

Abstract

Introduction: Ulcerative colitis is chronic inflammatory condition affecting the colon, necessitating remission inducing therapeutic interventions. With the emergence of newer more advanced options, their relative effectiveness remains unclear. This network meta-analysis (NMA) will compare the effectiveness of presently available biologics and small molecules in achieving and maintaining remission among patients of moderate-to-severe ulcerative colitis as part of induction and maintenance therapy.

Methods: A systematic search was conducted up to 21st February 2025, including only phase 2b/3 or 3 randomized controlled trials. The primary outcome was induction and maintenance of clinical remission (Full Mayo Score (FMS) ≤ 2, with no individual subscore > 1). Secondary outcomes assessed were clinical response, endoscopic improvement (Mayo Endoscopic Score (MES) ≤ 1 either with or without friability) and steroid free remission.

Results: Across 22 studies (7,683 patients), upadacitinib had the highest likelihood of inducing clinical remission (99.08%), clinical response (97.44%) and endoscopic improvement (99.32%), followed by Infliximab and guselkumab following close by for specific outcomes. In maintenance of clinical remission and endoscopic improvement upadacitinib again ranked highest (95.60%) and (99.46%). Tofacitinib (92.43%) has the highest probability with upadacitinib (87.73%) following behind in achieving steroid free remission.

Conclusion: Upadacitinib displayed high efficacy across multiple outcomes in both induction and maintenance therapy with Infliximab, guselkumab, and filgotinib following closely behind. For achieving steroid free remission tofacitinib has the highest probability of doing so. Overall small molecules and selective IL-23 inhibitors seems promising alternative to older biologics though additional head-to-head trial are warranted along with more real-world data.

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药物干预治疗溃疡性结肠炎的比较疗效：网络荟萃分析。

简介：溃疡性结肠炎是影响结肠的慢性炎症性疾病，需要缓解诱导治疗干预。随着更新更先进的选择的出现，它们的相对有效性仍不清楚。该网络meta分析（NMA）将比较目前可用的生物制剂和小分子药物在诱导和维持治疗中重度溃疡性结肠炎患者中实现和维持缓解的有效性。方法：系统检索至2025年2月21日，仅包括2b/3期或3期随机对照试验。主要结局是诱导和维持临床缓解（全梅奥评分（Full Mayo Score， FMS）≤2，无个体亚评分bbb1）。评估的次要结局是临床反应、内镜改善（Mayo内镜评分(MES)≤1，有无易损）和无类固醇缓解。结果：在22项研究（7683例患者）中，upadacitinib诱导临床缓解（99.08%）、临床缓解（97.44%）和内镜下改善（99.32%）的可能性最高，其次是英夫利昔单抗和guselkumab。在维持临床缓解和内镜下改善方面，upadacitinib再次排名最高（95.60%）和（99.46%）。托法替尼（92.43%）获得无类固醇缓解的概率最高，其次是upadacitinib（87.73%）。结论：Upadacitinib在诱导和维持治疗中显示出高疗效，英夫利昔单抗、guselkumab和非戈替尼紧随其后。对于实现无类固醇缓解，托法替尼的可能性最高。总的来说，小分子和选择性IL-23抑制剂似乎是旧生物制剂的有希望的替代品，尽管需要额外的头对头试验和更多的实际数据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Inflammopharmacology IMMUNOLOGYTOXICOLOGY-TOXICOLOGY

CiteScore

8.00

自引率

3.40%

发文量

200

期刊介绍： Inflammopharmacology is the official publication of the Gastrointestinal Section of the International Union of Basic and Clinical Pharmacology (IUPHAR) and the Hungarian Experimental and Clinical Pharmacology Society (HECPS). Inflammopharmacology publishes papers on all aspects of inflammation and its pharmacological control emphasizing comparisons of (a) different inflammatory states, and (b) the actions, therapeutic efficacy and safety of drugs employed in the treatment of inflammatory conditions. The comparative aspects of the types of inflammatory conditions include gastrointestinal disease (e.g. ulcerative colitis, Crohn''s disease), parasitic diseases, toxicological manifestations of the effects of drugs and environmental agents, arthritic conditions, and inflammatory effects of injury or aging on skeletal muscle. The journal has seven main interest areas: -Drug-Disease Interactions - Conditional Pharmacology - i.e. where the condition (disease or stress state) influences the therapeutic response and side (adverse) effects from anti-inflammatory drugs. Mechanisms of drug-disease and drug disease interactions and the role of different stress states -Rheumatology - particular emphasis on methods of measurement of clinical response effects of new agents, adverse effects from anti-rheumatic drugs -Gastroenterology - with particular emphasis on animal and human models, mechanisms of mucosal inflammation and ulceration and effects of novel and established anti-ulcer, anti-inflammatory agents, or antiparasitic agents -Neuro-Inflammation and Pain - model systems, pharmacology of new analgesic agents and mechanisms of neuro-inflammation and pain -Novel drugs, natural products and nutraceuticals - and their effects on inflammatory processes, especially where there are indications of novel modes action compared with conventional drugs e.g. NSAIDs -Muscle-immune interactions during inflammation [...]