Department of Medicine, Indira Gandhi Hospital, New Delhi, India.
Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Am J Gastroenterol. 2023 Sep 1;118(9):1618-1625. doi: 10.14309/ajg.0000000000002263. Epub 2023 Mar 29.
Rapidity of symptom resolution informs treatment choice in patients with moderate-severe ulcerative colitis (UC). We conducted a systematic review and network meta-analysis comparing early symptomatic remission with approved therapies.
Through a systematic literature review to December 31, 2022, we identified randomized trials in adult outpatients with moderate-severe UC treated with approved therapies (tumor necrosis factor α antagonists, vedolizumab, ustekinumab, janus kinase inhibitors, or ozanimod), compared with each other or placebo, reporting rates of symptomatic remission (based on partial Mayo score, with resolution of rectal bleeding and near-normalization of stool frequency) at weeks 2, 4, and/or 6. We performed random-effects network meta-analysis using a frequentist approach and estimated relative risk (RR) and 95% confidence interval values.
On network meta-analysis, upadacitinib was more effective than all agents in achieving symptomatic remission at weeks 2 (range of RR, 2.85-6.27), 4 (range of RR, 1.78-2.37), and 6 (range of RR, 1.84-2.79). Tumor necrosis factor α antagonists and filgotinib, but not ustekinumab and vedolizumab, were more effective than ozanimod in achieving symptomatic remission at week 2, but not at weeks 4 and 6. With approximately 10% placebo-treated patients achieving symptomatic remission at 2 weeks, we estimated 68%, 22%, 23.7%, 23.9%, 22.2%, 18.4%, 15.7%, and 10.9% of upadacitinib-, filgotinib-, infliximab-, adalimumab-, golimumab-, ustekinumab-, vedolizumab-, and ozanimod-treated patients would achieve early symptomatic remission, ustekinumab and vedolizumab achieving rapid remission only in biologic-naïve patients.
In a systematic review and network meta-analysis, upadacitinib was most effective in achieving early symptomatic remission, whereas ozanimod was relatively slower acting.
在中重度溃疡性结肠炎（UC）患者中，症状缓解的速度决定了治疗选择。我们进行了一项系统评价和网络荟萃分析，比较了早期症状缓解与已批准疗法的疗效。
通过系统文献回顾，我们在 2022 年 12 月 31 日之前，确定了在接受已批准疗法（肿瘤坏死因子α拮抗剂、vedolizumab、ustekinumab、Janus 激酶抑制剂或 ozanimod）治疗的中度至重度 UC 成年门诊患者中进行的随机试验，比较了彼此之间或安慰剂的症状缓解率（基于部分 Mayo 评分，直肠出血缓解且粪便频率接近正常）在第 2、4 和/或 6 周。我们使用贝叶斯方法进行了随机效应网络荟萃分析，并估计了相对风险（RR）和 95%置信区间值。
在网络荟萃分析中，upadacitinib 在第 2、4 和 6 周时比所有药物更有效地实现症状缓解（RR 范围为 2.85-6.27、1.78-2.37 和 1.84-2.79）。肿瘤坏死因子α拮抗剂和 filgotinib 比 ozanimod 更有效，但 ustekinumab 和 vedolizumab 更有效在第 2 周时实现症状缓解，但在第 4 和 6 周时没有。大约 10%接受安慰剂治疗的患者在第 2 周时实现症状缓解，我们估计 upadacitinib、filgotinib、infliximab、adalimumab、golimumab、ustekinumab、vedolizumab 和 ozanimod 治疗的患者中分别有 68%、22%、23.7%、23.9%、22.2%、18.4%、15.7%和 10.9%会实现早期症状缓解，ustekinumab 和 vedolizumab 仅在生物初治患者中实现快速缓解。
在一项系统评价和网络荟萃分析中，upadacitinib 在实现早期症状缓解方面最有效，而 ozanimod 起效相对较慢。
