Efficacy and Safety of Advanced Oral Small Molecules for Inflammatory Bowel Disease: Systematic Review and Meta-Analysis.
J Crohns Colitis
; 17(11): 1800-1816, 2023 Nov 24.
Article
em En
| MEDLINE
| ID: mdl-37317532
ABSTRACT
BACKGROUND AND AIMS:
Oral small-molecule drugs [SMDs] are expanding the therapeutic landscape for inflammatory bowel disease [IBD]. This systematic review and meta-analysis summarizes the efficacy and safety of JAK inhibitor [JAKi] and sphingosine-1-phosphate [S1P] receptor modulator treatments for ulcerative colitis [UC] and Crohn's disease [CD].METHODS:
MEDLINE, Embase, and CENTRAL were searched from inception to May 30, 2022. Randomized controlled trials [RCTs] of JAKi and S1P receptor modulators in adults with UC or CD were eligible. Clinical, endoscopic, histological, and safety data were pooled and analysed using a random-effects model.RESULTS:
Thirty-five RCTs [26 UC, nine CD] were included. In UC, JAKi therapy was associated with induction of clinical (risk ratio [RR] 3.16, 95% confidence interval [CI] 2.03-4.92; I2â =â 65%) and endoscopic [RR 3.99, 95% CI 2.36-6.75; I2â =â 36%] remission compared to placebo. Upadacitinib was associated with histological response [RR 2.63, 95% CI 1.97-3.53]. S1P modulator therapy was associated with induction of clinical [RR 2.52, 95% CI 1.88-3.39; I2â =â 1%] and endoscopic [RR 2.39, 95% CI 1.07-5.33; I2â =â 0%] remission relative to placebo. Ozanimod was superior to placebo for inducing histological remission in UC [RR 2.20, 95% CI 1.43-3.37; I2â =â 0%], while etrasimod was not [RR 2.36, 95% CI 0.71-7.88; I2â =â 0%]. In CD, JAKi therapy was superior to placebo for induction of clinical remission [RR 1.53, 95% CI 1.19-1.98; I2â =â 31%], and endoscopic remission [RR 4.78, 95% CI 1.63-14.06; I2â =â 43%] compared to placebo. The risk of serious infections was similar for oral SMDs and placebo.CONCLUSION:
JAKi and S1P receptor modulator therapies are effective in IBD for inducing clinical and endoscopic remission and, in some circumstances, histological response.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças Inflamatórias Intestinais
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Colite Ulcerativa
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Doença de Crohn
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Inibidores de Janus Quinases
Tipo de estudo:
Clinical_trials
/
Systematic_reviews
Limite:
Adult
/
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article