Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis
Abstract Background Therapeutic options for ulcerative colitis (UC) have increased since the introduction of biologics a few decades ago. Due to the wide range of biologics available, physicians have difficulty in selecting biologics and do not know how to balance the best drug between clinical effi...
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-023-02938-6 |
| _version_ | 1797452456405237760 |
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| author | Xinqiao Chu Yaning Biao Chengjiang Liu Yixin Zhang Chenxu Liu Ji-zheng Ma Yufeng Guo Yaru Gu |
| author_facet | Xinqiao Chu Yaning Biao Chengjiang Liu Yixin Zhang Chenxu Liu Ji-zheng Ma Yufeng Guo Yaru Gu |
| author_sort | Xinqiao Chu |
| collection | DOAJ |
| description | Abstract Background Therapeutic options for ulcerative colitis (UC) have increased since the introduction of biologics a few decades ago. Due to the wide range of biologics available, physicians have difficulty in selecting biologics and do not know how to balance the best drug between clinical efficacy and safety. This study aimed to compare the efficacy and safety of biologics in treating ulcerative colitis. Methods In this study, eight electronic databases (PubMed, Web of Science, Cochrane, Embase, Sinomed, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data) were searched to collect eligible studies without language restrictions. Retrieved 1 June 2023, from inception. All articles included in the mesh analysis are randomised controlled trials (RCTs). The inclusion of drugs for each outcome was ranked using a curved surface under cumulative ranking (SUCRA). Higher SUCRA scores were associated with better outcomes, whereas lower SUCRA scores were associated with better safety. This study has registered with PROSPERO, CRD42023389483. Results Induction Therapy: Among the biologic therapies evaluated for induction therapy, vedolizumab demonstrated the highest efficacy in achieving clinical remission (OR vs daclizumab, 9.09; 95% CI, 1.01–81.61; SUCRA 94.1) and clinical response. Guselkumab showed the lowest risk of recurrence of UC (SUCRA 94.9%), adverse events resulting in treatment discontinuation (SUCRA 94.8%), and serious infections (SUCRA 78.0%). Maintenance Therapy: For maintenance therapy, vedolizumab ranked highest in maintaining clinical remission (OR vs mesalazine 4.36; 95% CI, 1.65–11.49; SUCRA 89.7) and endoscopic improvement (SUCRA 92.6). Infliximab demonstrated the highest efficacy in endoscopic improvement (SUCRA 92.6%). Ustekinumab had the lowest risk of infections (SUCRA 92.9%), serious adverse events (SUCRA 91.3%), and serious infections (SUCRA 67.6%). Conclusion Our network meta-analysis suggests that vedolizumab is the most effective biologic therapy for inducing and maintaining clinical remission in UC patients. Guselkumab shows promise in reducing the risk of recurrence and adverse events during induction therapy. Infliximab is effective in improving endoscopic outcomes during maintenance therapy. Ustekinumab appears to have a favorable safety profile. These findings provide valuable insights for clinicians in selecting the most appropriate biologic therapy for UC patients. |
| first_indexed | 2024-03-09T15:09:02Z |
| format | Article |
| id | doaj.art-977e5c32627f4d4c800cbf4e41fa83cc |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-03-09T15:09:02Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-977e5c32627f4d4c800cbf4e41fa83cc2023-11-26T13:30:12ZengBMCBMC Gastroenterology1471-230X2023-10-0123111710.1186/s12876-023-02938-6Network meta-analysis on efficacy and safety of different biologics for ulcerative colitisXinqiao Chu0Yaning Biao1Chengjiang Liu2Yixin Zhang3Chenxu Liu4Ji-zheng Ma5Yufeng Guo6Yaru Gu7Guang’anmen Hospital, China Academy of Chinese Medical Sciences - No.5, Beixian PavilionSchool of Pharmacy, Hebei University of Chinese MedicineDepartment of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical UniversitySchool of Basic Medicine, Hebei University of Chinese MedicineSchool of Basic Medicine, Hebei University of Chinese MedicineGuang’anmen Hospital, China Academy of Chinese Medical Sciences - No.5, Beixian PavilionGuang’anmen Hospital, China Academy of Chinese Medical Sciences - No.5, Beixian PavilionSchool of Basic Medicine, Hebei University of Chinese MedicineAbstract Background Therapeutic options for ulcerative colitis (UC) have increased since the introduction of biologics a few decades ago. Due to the wide range of biologics available, physicians have difficulty in selecting biologics and do not know how to balance the best drug between clinical efficacy and safety. This study aimed to compare the efficacy and safety of biologics in treating ulcerative colitis. Methods In this study, eight electronic databases (PubMed, Web of Science, Cochrane, Embase, Sinomed, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data) were searched to collect eligible studies without language restrictions. Retrieved 1 June 2023, from inception. All articles included in the mesh analysis are randomised controlled trials (RCTs). The inclusion of drugs for each outcome was ranked using a curved surface under cumulative ranking (SUCRA). Higher SUCRA scores were associated with better outcomes, whereas lower SUCRA scores were associated with better safety. This study has registered with PROSPERO, CRD42023389483. Results Induction Therapy: Among the biologic therapies evaluated for induction therapy, vedolizumab demonstrated the highest efficacy in achieving clinical remission (OR vs daclizumab, 9.09; 95% CI, 1.01–81.61; SUCRA 94.1) and clinical response. Guselkumab showed the lowest risk of recurrence of UC (SUCRA 94.9%), adverse events resulting in treatment discontinuation (SUCRA 94.8%), and serious infections (SUCRA 78.0%). Maintenance Therapy: For maintenance therapy, vedolizumab ranked highest in maintaining clinical remission (OR vs mesalazine 4.36; 95% CI, 1.65–11.49; SUCRA 89.7) and endoscopic improvement (SUCRA 92.6). Infliximab demonstrated the highest efficacy in endoscopic improvement (SUCRA 92.6%). Ustekinumab had the lowest risk of infections (SUCRA 92.9%), serious adverse events (SUCRA 91.3%), and serious infections (SUCRA 67.6%). Conclusion Our network meta-analysis suggests that vedolizumab is the most effective biologic therapy for inducing and maintaining clinical remission in UC patients. Guselkumab shows promise in reducing the risk of recurrence and adverse events during induction therapy. Infliximab is effective in improving endoscopic outcomes during maintenance therapy. Ustekinumab appears to have a favorable safety profile. These findings provide valuable insights for clinicians in selecting the most appropriate biologic therapy for UC patients.https://doi.org/10.1186/s12876-023-02938-6Ulcerative colitisBiologicsNetwork meta-analysisSystematic review |
| spellingShingle | Xinqiao Chu Yaning Biao Chengjiang Liu Yixin Zhang Chenxu Liu Ji-zheng Ma Yufeng Guo Yaru Gu Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis BMC Gastroenterology Ulcerative colitis Biologics Network meta-analysis Systematic review |
| title | Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis |
| title_full | Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis |
| title_fullStr | Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis |
| title_full_unstemmed | Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis |
| title_short | Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis |
| title_sort | network meta analysis on efficacy and safety of different biologics for ulcerative colitis |
| topic | Ulcerative colitis Biologics Network meta-analysis Systematic review |
| url | https://doi.org/10.1186/s12876-023-02938-6 |
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