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Systematic review with meta‐analysis: comparative efficacy of biologics for induction and maintenance of mucosal healing in Crohn's disease and ulcerative colitis controlled trials

2017; Wiley; Volume: 45; Issue: 10 Linguagem: Inglês

10.1111/apt.14030

1365-2036

Aurada Cholapranee, Glen Hazlewood, Gilaad G. Kaplan, Laurent Peyrin‐Biroulet, Ashwin N. Ananthakrishnan,

Helicobacter pylori-related gastroenterology studies

Summary Background Mucosal healing is an important therapeutic endpoint in the management of Crohn's disease ( CD ) and ulcerative colitis ( UC ). Limited data exist regarding the comparative efficacy of various therapies in achieving this outcome. Aim To perform a systematic review and meta‐analysis of biologics for induction and maintenance of mucosal healing in Crohn's disease and ulcerative colitis. Methods We performed a systematic review and meta‐analysis of randomised controlled trials ( RCT ) examining mucosal healing as an endpoint of immunosuppressives, anti‐tumour necrosis factor α (anti‐ TNF ) or anti‐integrin monoclonal antibody therapy for moderate‐to‐severe CD or UC . Pooled effect sizes for induction and maintenance of mucosal healing were calculated and pairwise treatment comparisons evaluated using a Bayesian network meta‐analysis. Results A total of 12 RCT s were included in the meta‐analysis ( CD – 2 induction, 4 maintenance; UC – 8 induction, 5 maintenance). Duration of follow‐up was 6–12 weeks for induction and 32‐54 weeks for maintenance trials. In CD , anti‐ TNF s were more effective than placebo for maintaining mucosal healing [28% vs. 1%, Odds ratio ( OR ) 19.71, 95% confidence interval ( CI ) 3.51–110.84]. In UC , anti‐ TNF s and anti‐integrins were more effective than placebo for inducing (45% vs. 30%) and maintaining mucosal healing (33% vs. 18%). In network analysis, adalimumab therapy was inferior to infliximab [ OR 0.45, 95% credible interval (CrI) 0.25–0.82] and combination infliximab‐azathioprine ( OR 0.32, 95% CrI 0.12–0.84) for inducing mucosal healing in UC . There was no statistically significant pairwise difference between vedolizumab and anti‐ TNF agents in UC . Conclusions Anti‐ TNF and anti‐integrin biological agents are effective in inducing mucosal healing in UC , with adalimumab being inferior to infliximab or combination therapy. Infliximab and adalimumab were similar in CD .