Comparative Efficacy of Advanced Therapies for Achieving Endoscopic Outcomes in Crohn's Disease: A Systematic Review and Network Meta-Analysis
Abstract
BACKGROUND & AIMS
We conducted a network meta-analysis to compare the efficacy of advanced therapies for achieving endoscopic outcomes in patients with moderate to severely active CD.
METHODS
MEDLINE, Embase, and Cochrane CENTRAL databases were searched from inception to Aug 2, 2023 to identify phase-II and III randomized controlled trials (RCTs) in 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 with placebo/active comparator, for induction and/or maintenance of remission and reported endoscopic outcomes. Primary outcome was endoscopic response after induction therapy, and endoscopic remission after maintenance therapy. We performed a random-effects network meta-analysis using a frequentist approach, and estimated relative risk (RRs), 95% CI values and p-score for ranking agents. We used GRADE to ascertain certainty of evidence.
RESULTS
A total of twenty RCTs (19 placebo-controlled and one head-to-head trial; 5592 patients) were included out of which 12 RCTs reported endoscopic outcomes for the induction phase, five reported for the maintenance phase and three reported for both induction and maintenance phases. JAK1 inhibitors (RR 3∙49 [95% CI, 1∙48-8∙26]) and anti-IL23p19 (RR 2∙30 [1∙02-5∙18]) agents were more efficacious than etrolizumab (moderate certainty of evidence), and JAK1 inhibitors (RR 2∙34…
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: 5,592 participants or records.
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