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

IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Brigida Barberio, David J. Gracie, Christopher J. Black, Alexander C. Ford
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引用次数: 0

Abstract

Background

Numerous biologics and small molecules are licensed as maintenance therapy for ulcerative colitis (UC). Differences in the design of randomised controlled trials (RCTs) have not been considered when comparing efficacy between them.

Aims

To examine the relative efficacy of biologics and small molecules by network meta-analysis according to trial design.

Methods

We searched the literature to 27 February 2025 for RCTs. We judged efficacy using clinical remission, endoscopic improvement, endoscopic remission, or corticosteroid-free remission and according to previous exposure or non-exposure to advanced therapies. Random effects model with data reported as pooled relative risks (RR) with 95% confidence intervals (CI); drugs ranked by p-score.

Results

We identified 28 RCTs, 16 re-randomising 6568 patients and 12 treating through 3771 patients. In re-randomised studies, upadacitinib 30 mg o.d. ranked first for clinical remission (RR of failure to achieve clinical remission = 0.52; 95% CI 0.44–0.61, p-score 0.99) and endoscopic improvement (RR = 0.43; 95% CI 0.35–0.52, p-score 0.99). Vedolizumab 300 mg 4-weekly ranked first for endoscopic remission (RR = 0.73; 95% CI 0.64–0.84, p-score 0.92) and guselkumab 200 mg 4-weekly first for corticosteroid-free remission (RR = 0.40; 95% CI 0.28–0.55, p-score 0.95). In treat-through studies, etrasimod 2 mg o.d. ranked first for clinical remission (RR = 0.73; 95% CI 0.64–0.83, p-score 0.88) and infliximab 10 mg/kg 8-weekly first for endoscopic improvement (RR = 0.64; 95% CI 0.56–0.74, p-score 0.94).

Conclusion

In network meta-analysis, upadacitinib and etrasimod were consistently efficacious as maintenance therapy in UC.

Abstract Image

网络荟萃分析:生物疗法和小分子维持疗法在溃疡性结肠炎中的疗效。
背景:许多生物制剂和小分子药物被批准用于溃疡性结肠炎(UC)的维持治疗。在比较它们之间的疗效时,没有考虑随机对照试验(rct)设计的差异。目的根据试验设计,采用网络meta分析方法,比较生物制剂与小分子制剂的相对疗效。方法检索截至2025年2月27日的文献,纳入随机对照试验。我们通过临床缓解、内窥镜改善、内窥镜缓解或无皮质类固醇缓解以及先前接受或未接受先进治疗来判断疗效。随机效应模型,数据报告为汇总相对风险(RR), 95%置信区间(CI);药物按p值排序。结果:共纳入28项随机对照试验,16项再随机纳入6568例患者,12项治疗纳入3771例患者。在再随机研究中,upadacitinib 30mg o.d.在临床缓解方面排名第一(未能达到临床缓解的RR = 0.52;95% CI 0.44-0.61, p-score 0.99)和内镜下改善(RR = 0.43;95% CI 0.35-0.52, p-score 0.99)。Vedolizumab 300 mg 4周在内镜缓解方面排名第一(RR = 0.73;95% CI 0.64-0.84, p评分0.92)和guselkumab 200mg 4周首次用于无皮质类固醇缓解(RR = 0.40;95% CI 0.28-0.55, p-score 0.95)。在贯穿治疗的研究中,伊拉西莫德2mg o.d在临床缓解方面排名第一(RR = 0.73;95% CI 0.64-0.83, p评分0.88)和英夫利昔单抗10 mg/kg 8周首次用于内镜改善(RR = 0.64;95% CI 0.56-0.74, p-score 0.94)。结论在网络荟萃分析中,upadacitinib和etrasimod作为UC的维持治疗是一致有效的。
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来源期刊
CiteScore
15.60
自引率
7.90%
发文量
527
审稿时长
3-6 weeks
期刊介绍: Alimentary Pharmacology & Therapeutics is a global pharmacology journal focused on the impact of drugs on the human gastrointestinal and hepato-biliary systems. It covers a diverse range of topics, often with immediate clinical relevance to its readership.
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