Comparative Improvement in Health-Related Quality of Life with Advanced Therapies for Moderate-to-Severe Crohn's Disease: A Network Meta-Analysis.

BACKGROUND AND AIMS The comparative efficacy of advanced therapies to improve health-related quality of life (HR-QoL) in Crohn's disease (CD) is unknown. We aimed to compare the impact of approved advanced therapies for moderate-to-severe CD on HR-QoL. METHODS We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to December 2023. We included randomized controlled trials (RCTs) that assessed approved advanced therapies for the treatment of adults with moderate-to-severe luminal CD. The primary outcome was change from baseline in the Inflammatory Bowel Disease Questionnaire (IBDQ). Pairwise random-effects meta-analyses were conducted, and we reported results as mean differences (MD) for continuous outcomes and risk ratios for binary outcomes, with corresponding 95% confidence intervals (CI). A random-effects frequentist network meta-analysis was conducted, and the competing interventions were ranked using the P-score. RESULTS Our search strategy 34 records that fulfilled our eligibility criteria. In pairwise meta-analysis, advanced therapies were associated with improvements in IBDQ score (MD 16.07, 95% CI 12.59 - 19.54) after induction. In network meta-analysis, upadacitinib 45mg ranked first for change in IBDQ after induction (MD 23.10, 95% CI 14.41 - 31.78, P-score 0.86). For maintenance studies, advanced therapies showed a significant improvement in IBDQ score in pairwise meta-analysis (MD 12.72, 95% CI 10.47 - 14.97). Infliximab 10mg/kg ranked first for change in IBDQ after maintenance (MD 24.91, 95% CI 12.99 - 36.83, P-score 0.90). CONCLUSION Advanced therapies were associated with improvements in HR-QoL after induction and maintenance. Upadacitinib 45mg and infliximab 10mg/kg ranked highest after induction and maintenance, respectively.