Biologics effectively induce, maintain mucosal healing in IBD
Anti-TNF agents are effective for maintaining mucosal healing in Crohn’s disease, while anti-TNFs and anti-integrins are comparably effective for inducing and maintaining mucosal healing in ulcerative colitis, according to the results of a systematic review and meta-analysis comparing biologics.
“As we are entering the era where we anticipate there will be many new treatments, each targeting inflammation differently, it is also important to understand the relative efficacy of these therapies in achieving our goal of mucosal healing to appropriately position them in our treatment algorithms,” Ashwin N. Ananthakrishnan, MD, MPH, of Harvard Medical School and Massachusetts General Hospital, said in a press release.
Ashwin N. Ananthakrishnan
This is because mucosal healing has emerged as a “more ambitious” therapeutic goal than symptom relief, as patients who achieve mucosal healing “have a superior long-term prognosis including lower risk of surgery, hospitalizations, and need for systemic steroids,” he and colleagues wrote.
They included 12 randomized controlled trials of immunosuppressives, anti-TNFs and anti-integrins published up to 2015 in their meta-analysis. Two evaluated induction and four evaluated maintenance of mucosal healing in moderate-to-severe Crohn’s disease, and eight evaluated induction and five evaluated maintenance of mucosal healing in moderate-to-severe ulcerative colitis. Follow-up ranged from 6 to 12 weeks for induction studies and 32 to 54 weeks for maintenance studies.
Overall, they determined that anti-TNFs were more effective than placebo for maintaining mucosal healing in Crohn’s disease (28% vs. 1%; OR = 19.71; 95% CI, 3.51-110.84), while anti-TNFs and anti-integrins were both more effective than placebo for inducing (45% vs. 30%; OR = 1.99; 95% CI, 1.53-2.58) and maintaining (33% vs. 18%; OR = 2.59; 95% CI, 1.84-3.66) mucosal healing in ulcerative colitis.
Further analysis showed that Humira (adalimumab, AbbVie) was less effective than Remicade (infliximab, Janssen; OR = 0.45; 95% credible interval [CrI], 0.25-0.82) and combination therapy with infliximab and azathioprine (OR = 0.32; 95% CrI, 0.12-0.84) for inducing mucosal healing in ulcerative colitis. No significant pairwise differences were observed between Entyvio (vedolizumab, Takeda) and anti-TNFs in ulcerative colitis.
“Between-drug differences exist within each therapeutic class, particularly for induction of mucosal healing in UC, [with] infliximab or combination therapy being the preferred strategy,” the investigators wrote.
The need for direct head-to-head studies evaluating the efficacy of all approved agents for inducing and maintaining mucosal healing is “important and urgent,” they concluded. – by Adam Leitenberger
Disclosures: Ananthakrishnan reports he has received funding from the NIH, served on scientific advisory boards for AbbVie, Cubist and Exact Sciences, and received research funding from Merck and Amgen. Please see the full study for a list of all researchers’ relevant financial disclosures.