The following is a summary of “Comparative Efficacy of Advanced Therapies for Achieving Endoscopic Outcomes in Crohn’s Disease: A Systematic Review and Network Meta-Analysis,” published in the January 2024 issue of Gastroenterology by Vuyyuru et al.
Researchers conducted a retrospective study to assess how various advanced therapies stack up in achieving endoscopic remission for moderate-to-severe Crohn’s disease (CD).
They conducted searches on MEDLINE, Embase, and Cochrane CENTRAL databases from inception (Aug 2, 2023), identifying phase-II and III RCTs involving adults (≥18 years) with moderate-to-severe CD treated with tumor necrosis factor (TNF) antagonists, etrolizumab, vedolizumab, anti-interleukin (IL)-12/23p40, anti-IL23p19, or Janus kinase-1 (JAK1) inhibitors. Compared treatments for remission induction and maintenance, emphasizing reported endoscopic results. The primary outcomes were endoscopic response after induction therapy and endoscopic remission after maintenance therapy. They used meta-analysis to estimate relative risks, 95% CIs, and p-scores for ranking agents. The certainty of evidence was determined using GRADE.
The results showed 20 RCTs (19 placebo-controlled and one head-to-head trial; 5592 patients). Out of these, 12 RCTs reported endoscopic outcomes for the induction phase, five for the maintenance phase, and three for both phases. JAK1 inhibitors (RR 3.49 [95% CI, 1.48-8.26]) and anti-IL23p19 (RR 2.30 [1.02-5.18]) were more effective than etrolizumab (moderate certainty of evidence). JAK1 inhibitors (RR 2.34 [1.14-4.80]) were more effective than anti-IL12/23p40 agents for inducing endoscopic response (moderate certainty of evidence). JAK1 inhibitors and anti-IL-23p19 ranked highest for inducing endoscopic response. There were few RCTs of TNF antagonists reporting endoscopic outcomes with induction therapy. In a network meta-analysis of six RCTs, all agents, except vedolizumab (RR 1.89 [95% CI: 0.61-5.92]), effectively maintained endoscopic remission compared with placebo. TNF antagonists, IL12/23p40, and JAK1 inhibitors ranked highest.
They concluded that JAK1 and anti-IL23p19 inhibitors induced endoscopic response in Crohn’s disease, paving the way for future treatment strategies.
Source: sciencedirect.com/science/article/abs/pii/S154235652400003X
