Remicade ranked highest for induction of remission and endoscopic improvement among biologic-naive patients, according to a meta-analysis of treatments for moderately to severely active ulcerative colitis.
In the same study, Stelara (ustekinumab, Janssen) and Xeljanz (tofacitinib, Pfizer) had the best results among patients who had been previously exposed to anti-TNF therapy.
“Several treatment options are now available for the management of moderate-severe ulcerative colitis, with variable efficacy and safety profiles, and positioning different agents in treatment course, as first-line and second-line is a key knowledge gap,” Siddharth Singh, MD, MS, of the division of gastroenterology at the University of California, San Diego, and colleagues wrote. “With the recent labeling and dosing change for tofacitinib in light of safety considerations, recent publication of the first head-to-head trial comparing [Entyvio (vedolizumab, Takeda)] vs. [Humira (adalimumab, AbbVie)] in patients with moderate-severe ulcerative colitis and recent regulatory approval of ustekinumab for these patients, the results of these analyses warrant updating.”
Investigators searched the literature for randomized trials of adults with moderate to severe UC who were treated with a biologic agent compared with placebo or another agent. They assessed induction and maintenance of remission and endoscopic improvement, as well as serious adverse events and infection. Their final analysis included 17 randomized controlled trials.
Among biologic naive patients, Remicade (infliximab, Janssen) was ranked highest for induction of remission (OR vs. placebo = 4.07; 95% CI, 2.67–6.21) and endoscopic improvement.
For patients who had previously been exposed to anti-TNF, ustekinumab and tofacitinib were superior to vedolizumab (OR = 5.99; 95% CI, 1.13–31.76; OR = 6.18; 95% CI, 1.003–8) and adalimumab (OR = 10.71; 95% CI, 2.01–57.2; OR = 11.05; 95% CI, 1.79–68.41).
In maintenance trials, vedolizumab and ustekinumab had the first and second lowest risk for infections.
“This updated analysis has key strengths with inclusion of the first head-to-head trial comparing vedolizumab and adalimumab, which forms a more connected network, and provides more robust, statistically and clinically significant results on comparative efficacy of second-line pharmacotherapy in patients with prior exposure to TNF alpha antagonists,” Singh and colleagues wrote. “With limited head-to-head trials, this information can directly inform clinical practice and guidelines and facilitate shared decision making for management of patients with moderate-severe ulcerative colitis.” – by Alex Young
Disclosure: Singh reports receiving research grants from AbbVie and consulting fees from AbbVie, AMAG Pharmaceuticals, Pfizer and Takeda. Please see the full study for all other authors’ relevant financial disclosures.