Comparative Efficacy of Advanced Therapies For Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis.

Details

• Alternative Title:
  Gastroenterology, 2024, v. 167, no. 7: Comparative Efficacy of Advanced Therapies For Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis.
• Journal Article:
  Gastroenterology
• Personal Author:
  Ananthakrishnan, Ashwin N. ; Murad, M. Hassan ; Scott, Frank I. ; Agrawal, Manasi ; Haydek, John P. ; Limketkai, Berkeley N. ; Loftus, Edward V ; Singh, Siddharth
• Description:
  We performed an updated systematic review and network meta-analysis to inform the 2024 American Gastroenterological Association (AGA) Clinical Guidelines on the management of moderate-to-severe ulcerative colitis (UC).
  
  We searched multiple electronic databases through November 21, 2023, to identify randomized controlled trials in adults with moderate-to-severe UC, comparing different advanced therapies (tumor necrosis factor antagonists, vedolizumab, sphingosine-1-phosphate receptor modulators, interleukin 12/23 or selective interleukin 23 antagonists, and Janus kinase JAK inhibitors) against placebo or another active comparator. Our primary outcomes were induction and maintenance of clinical remission, and our secondary outcome was endoscopic improvement. We performed a network meta-analysis using a frequentist approach and applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to appraise certainty of evidence.
  
  After excluding JAK inhibitors as potential first-line treatment (in accordance with the United States Food and Drug Administration), low-certainty evidence supports clinically important benefit with infliximab, ozanimod, risankizumab, and guselkumab over adalimumab and mirikizumab for achieving remission with induction therapy in biologically naïve patients with moderate-to-severe UC, with risankizumab and ozanimod being ranked the highest for induction of clinical remission. With the inclusion of JAK inhibitors as first-line therapy, upadacitinib was more efficacious compared with all other medications except ozanimod and risankizumab, with low- to moderate-certainty evidence. In patients with prior biologic exposure, upadacitinib, tofacitinib, and ustekinumab were ranked highest for achieving remission.
  
  Using Grading of Recommendations, Assessment, Development and Evaluation to appraise quality of evidence, this updated network meta-analysis will be used to inform comparative efficacy and positioning of advanced therapies for the treatment of biologic-naïve and biologic-exposed patients with moderate-to-severe UC.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Antibodies, Monoclonal, Humanized
  • Colitis, Ulcerative
  • Comparative Effectiveness Research
  • Gastroenterology
  • Gastrointestinal Agents
  • Janus Kinase Inhibitors
  • Piperidines
  • Randomized Controlled Trials as Topic
  • Remission Induction
  More +
• Keywords:
  • Positioning
  • biologics
  • guidelines
  • inflammatory bowel diseases
  • comparative effectiveness
• Source:
  Gastroenterology, 2024, v. 167, no. 7
• DOI:
  https://doi.org/10.1053/j.gastro.2024.07.046
• ISSN:
  0016-5085 ; 1528-0012
• Pubmed ID:
  39425738
• Pubmed Central ID:
  PMC12148344
• Document Type:
  Text
• Funding:
  K23 DK129762/DK/NIDDK NIH HHSUnited States/ ; R01 DK127171/DK/NIDDK NIH HHSUnited States/ ; R01 DK135937/DK/NIDDK NIH HHSUnited States/ ; U01 DP006745/DP/NCCDPHP CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  United States
• Pages in Document:
  1460-1482 (38 pdf pages)
• Volume:
  167
• Issue:
  7
• Download URL:
  https://stacks.cdc.gov/view/cdc/261972/cdc_261972_DS1.pdf
• File Type:
  [PDF - 1.40 MB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:ec1b934dd57382c6210370b365ad77364e525aa3f0a1c01c57db0de39048d5fd5703b6b21711a195364eae77e399b8bccba12c25d79108ce3bdbfa47f62d8eeb