Khan Atta Ullah, Ali Maria, Wahab Muhammad Aamir
Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy.
Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy.
Inflammopharmacology. 2025 Mar 29. doi: 10.1007/s10787-025-01723-z.
Ulcerative colitis is chronic inflammatory condition affecting the colon, necessitating remission inducing therapeutic interventions. With the emergence of newer more advanced options, their relative effectiveness remains unclear. This network meta-analysis (NMA) will compare the effectiveness of presently available biologics and small molecules in achieving and maintaining remission among patients of moderate-to-severe ulcerative colitis as part of induction and maintenance therapy.
A systematic search was conducted up to 21st February 2025, including only phase 2b/3 or 3 randomized controlled trials. The primary outcome was induction and maintenance of clinical remission (Full Mayo Score (FMS) ≤ 2, with no individual subscore > 1). Secondary outcomes assessed were clinical response, endoscopic improvement (Mayo Endoscopic Score (MES) ≤ 1 either with or without friability) and steroid free remission.
Across 22 studies (7,683 patients), upadacitinib had the highest likelihood of inducing clinical remission (99.08%), clinical response (97.44%) and endoscopic improvement (99.32%), followed by Infliximab and guselkumab following close by for specific outcomes. In maintenance of clinical remission and endoscopic improvement upadacitinib again ranked highest (95.60%) and (99.46%). Tofacitinib (92.43%) has the highest probability with upadacitinib (87.73%) following behind in achieving steroid free remission.
Upadacitinib displayed high efficacy across multiple outcomes in both induction and maintenance therapy with Infliximab, guselkumab, and filgotinib following closely behind. For achieving steroid free remission tofacitinib has the highest probability of doing so. Overall small molecules and selective IL-23 inhibitors seems promising alternative to older biologics though additional head-to-head trial are warranted along with more real-world data.
溃疡性结肠炎是一种影响结肠的慢性炎症性疾病，需要采用诱导缓解的治疗干预措施。随着更新、更先进的治疗方案的出现，它们的相对有效性仍不明确。这项网络荟萃分析（NMA）将比较目前可用的生物制剂和小分子药物在中重度溃疡性结肠炎患者诱导缓解和维持缓解治疗中实现并维持缓解的有效性。
截至2025年2月21日进行了系统检索，仅纳入2b/3期或3期随机对照试验。主要结局是诱导并维持临床缓解（完全梅奥评分（FMS）≤2，且单个分项评分均不>1）。评估的次要结局包括临床反应、内镜改善（梅奥内镜评分（MES）≤1，无论有无黏膜脆性增加）和无激素缓解。
在22项研究（7683例患者）中，乌帕替尼诱导临床缓解（99.08%）、临床反应（97.44%）和内镜改善（99.32%）的可能性最高，其次是英夫利昔单抗和古塞库单抗，在特定结局方面紧随其后。在维持临床缓解和内镜改善方面，乌帕替尼再次排名最高（分别为95.60%和99.46%）。托法替布（92.43%）在实现无激素缓解方面概率最高，乌帕替尼（87.73%）次之。
在诱导缓解和维持缓解治疗的多个结局方面，乌帕替尼均显示出高效，英夫利昔单抗、古塞库单抗和非戈替尼紧随其后。在实现无激素缓解方面，托法替布的概率最高。总体而言，小分子药物和选择性IL-23抑制剂似乎是比传统生物制剂更有前景的替代方案，不过仍需要更多的头对头试验以及更多真实世界数据。
