Ulcerative Colitis Resource Center

Ulcerative Colitis Resource Center

November 09, 2018
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More research needed to test comparative effectiveness of UC treatments

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Induction treatment with various biologic agents improved quality of life among patients with ulcerative colitis, according to research published in Alimentary Pharmacology & Therapeutics.

However, Paschalis Paschos, MD, MSc, of the clinical and evidence-based medicine unit at Aristotle University of Thessaloniki, in Greece, and colleagues wrote that more head-to-head trials are needed to inform decision making about their comparative effectiveness.

“Emerging novel treatment options further increase the uncertainty regarding selection of optimal therapy for ulcerative colitis,” they wrote. “In the absence of direct comparisons, indirect comparisons from network metaanalyses can be considered, under the assumption of transitivity. Existing network metaanalyses on UC have only assessed efficacy and safety of interventions and did not explore their impact on quality of life.”

Paschos and colleagues searched the literature for randomized controlled trials that compared Remicade (infliximab, Janssen), Humira (adalimumab, AbbVie), Simponi (golimumab, Janssen), Xeljanz (tofacitinib, Pfizer) and Entyvio (vedolizumab, Takeda) with placebo. The main outcomes were change in quality of life scores and the proportion of patients with improvement of quality of life.

Researchers identified 14 trials that fit their criteria that used either the inflammatory bowel disease questionnaire (n = 14), the Short Form questionnaire (n = 7), or the European Quality of Life-5 Dimensions questionnaire (n = 3) to assess quality of life.

Investigators found that at induction, evidence suggested that all treatments significantly improved quality of life scores compared with placebo, but only infliximab (mean difference = 18.58; 95% CI, 13.19–23.97) and vedolizumab (MD = 18; 95% CI, 11.08–24.92) showed clinically meaningful improvement to the IBDQ score.

While the agents helped reduce symptoms and helped improve patients’ social functioning and emotional status, Paschos and colleagues believed the evidence lacked credibility due to the possibility of bias in the data set. Additionally, they wrote that any differences they found between agents were inexact.

“Some of the relative effects were very imprecisely estimated while others were rather heterogeneous,” they wrote. “This limitation underlines the compelling need for adequately powered, high quality clinical trials to enhance the credibility of conclusions about differences among interventions.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.