Comparative Efficacy and Safety of Biologic Therapies for Moderate-to-Severe Crohn’s Disease: A Systematic Review and Network Meta-Analysis
Abstract
SUMMARY Background: Data to inform positioning of biologic therapy, both first line and after previous biologic exposure in the treatment of moderate-to-severe Crohn’s disease (CD) is required. We assessed the comparative efficacy and safety of biologics in CD. Methods: A systematic review and network meta-analysis including induction (≥14 days) or maintenance (≥22 weeks) randomized controlled trials (RCTs) in adults (≥18 years) with moderate-to-severe CD (Crohn’s Disease Activity Index CDAI 220–450) treated with tumor necrosis factor (TNF) antagonists, anti-integrin, anti-interleukin (IL)-12/23p40, or anti-IL23p19 agents, relative to placebo or an active comparator, was conducted. MEDLINE, EMBASE, CENTRAL, conference proceedings, trial registries and unpublished data were searched from inception to 03/06/2021. The primary endpoint was induction of clinical remission (CDAI <150), extracted from published reports. Network meta-analysis using multivariate consistency model random-effects meta-regression was performed, with rankings based on surface under the cumulative ranking (SUCRA) probability. Findings: Based on 15 RCTs in 2,931 biologic-naïve patients, infliximab monotherapy (OR 4.53 [95% CI: 1.49, 13.79]) or combined with azathioprine (OR 7.49 [95% CI: 2.04, 27.49]), adalimumab (OR 3.01 [95% CI: 1.25, 7.27]), and ustekinumab (OR 2.63 [95% CI: 1.10, 6.28]), were associated with higher odds of inducing remission compared to certolizumab pegol; infliximab and azathioprine…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,479 participants or records.
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