Department of Health Policy and Management, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland.
Division of Epidemiology and Preventive Medicine, Department of Epidemiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
Pharmacotherapy. 2024 Oct;44(10):811-821. doi: 10.1002/phar.4611. Epub 2024 Sep 25.
Ulcerative colitis (UC) is a serious health problem that requires a constant need to identify new effective drugs. The aim of this study was to assess the efficacy and safety of mirikizumab compared with other biologic drugs approved for the treatment of moderately to severely active UC. This systematic review with frequentist network meta-analysis (NMA) included randomized controlled trials (RCTs) that evaluated the use of adalimumab, golimumab, infliximab, mirikizumab, vedolizumab, and ustekinumab compared with placebo or with another approved biologic drug. The NMA was conducted using the netmeta R software package. The P score was used to determine the treatment ranking. A total of 14 RCTs were included in the analysis. No significant differences were observed in the incidence of clinical response and remission between mirikizumab and other drugs. Mirikizumab was superior to placebo for clinical response (induction: odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.63-3.48; maintenance: OR = 3.31, 95% CI: 1.59-6.89) and remission (induction: OR = 2.09, 95% CI: 1.20-3.63; maintenance: OR = 2.96; 95% CI: 1.62-5.40). The probability plot indicated that infliximab might be the most effective option in terms of both clinical response and remission (P score, 0.8971 and 0.8814, respectively) in induction phase. No significant differences were noted between the studied drugs in any adverse events (AEs), serious AEs (SAEs) and infections for the induction phase, and in any AEs, infections and serious infections for the maintenance phase. The drugs differed in terms of discontinuation due to AEs (induction and maintenance phases) as well as SAEs and serious infections (maintenance phase). Mirikizumab did not differ from other biologics in terms of clinical response and remission for both induction and maintenance phases in patients with UC. Mirikizumab during the induction phases achieved rank 3 for clinical response and rank 5 for clinical remission. Therefore, it represents a valuable treatment option. The lack of significant differences in the risk of AEs and SAEs suggests that mirikizumab has a similar safety profile to the other drugs.
溃疡性结肠炎(UC)是一个严重的健康问题,需要不断寻找新的有效药物。本研究旨在评估米利珠单抗与其他已批准用于治疗中重度活动期 UC 的生物药物相比的疗效和安全性。这项系统评价采用了频率网络荟萃分析(NMA),纳入了评估阿达木单抗、戈利木单抗、英夫利昔单抗、米利珠单抗、维得利珠单抗和乌司奴单抗与安慰剂或另一种已批准的生物药物相比的随机对照试验(RCT)。NMA 使用了 netmeta R 软件包。P 评分用于确定治疗排名。共有 14 项 RCT 纳入了分析。米利珠单抗与其他药物在临床缓解和缓解率方面没有显著差异。米利珠单抗在临床缓解(诱导:优势比[OR] = 2.38;95%置信区间[CI]:1.63-3.48;维持:OR = 3.31,95% CI:1.59-6.89)和缓解(诱导:OR = 2.09,95% CI:1.20-3.63;维持:OR = 2.96;95% CI:1.62-5.40)方面优于安慰剂。概率图表明,在诱导期,英夫利昔单抗在临床缓解和缓解方面可能是最有效的选择(P 评分分别为 0.8971 和 0.8814)。在诱导期,研究药物在任何不良事件(AE)、严重不良事件(SAE)和感染方面,以及在维持期的任何 AE、感染和严重感染方面均无显著差异。在诱导期和维持期,由于 AE 以及 SAE 和严重感染,药物之间存在停药差异。米利珠单抗在诱导和维持期的临床缓解和缓解方面与其他生物制剂没有差异。在诱导期,米利珠单抗的临床缓解排名第三,临床缓解排名第五。因此,它是一种有价值的治疗选择。AE 和 SAE 风险无显著差异表明,米利珠单抗与其他药物具有相似的安全性。