Comparative maintenance performance of all biologic agents and small molecules in ulcerative colitis: a network meta-analysis.
Eur J Gastroenterol Hepatol
; 36(5): 520-533, 2024 May 01.
Article
em En
| MEDLINE
| ID: mdl-38477863
ABSTRACT
BACKGROUND AND AIMS:
Βiologic agents and small molecules have expanded the therapeutic armamentarium of moderate to severe ulcerative colitis (UC). However, their comparative efficacy and safety performance as maintenance treatments have not been sufficiently explored. We performed a systematic review and network meta-analysis (NWM) to assess the comparative efficacy and safety of all approved and emerging treatments for maintenance in moderate to severe UC.METHODS:
We searched Pubmed/Medline, EMBASE, and Cochrane Library databases for relevant RCTs through April 2023. The primary endpoint was clinical remission at the end of the maintenance therapy. Data were analyzed by means of a Bayesian NWM. The ranking probability concerning efficacy and safety was evaluated by means of surfaces under cumulative ranking (SUCRA) values.RESULTS:
There were 20 eligible RCTs with 7660 patients randomized to 20 treatments. RCTs were grouped into two study designs, that is, re-randomization of patients after an induction period and treat-through patients. Concerning efficacy, in re-randomized patients, upadacitinib 30â mg/day was ranked first (SUCRA 94.9%) whereas in treat-through patients etrasimod 2â mg/day was ranked first (SUCRA 91.1%). The integrated efficacy-safety hierarchical analysis, showed that tofacitinib 10â mg had the best efficacy-safety therapeutic profile in re-randomized patients, whereas in treat-through patients infliximab 3.5â mg/Kg Q8W showed the best efficacy-safety profile.CONCLUSION:
For maintenance treatment, in moderate to severe UC, this NWM showed that upadacitinib 30â mg/day and etrasimod 2â mg/day were ranked best for efficacy in re-randomized and treat-through patients respectively. Tofacitinib 10â mg/day and infliximab 3.5â mg/Kg Q8W showed the best efficacy-safety therapeutic profile in re-randomized and treat-through patients respectively.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Produtos Biológicos
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Colite Ulcerativa
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Indóis
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Acetatos
Limite:
Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article