Antibodies against tumor necrosis factor-alpha (anti-TNF) are effective therapies in the treatment of ulcerative colitis, but their comparative efficacy is unknown.
Dr Waljee and colleagues from Michigan, USA performed a network meta-analysis comparing the efficacy of anti-TNF agents in ulcerative colitis.
After screening 506 studies, reviewers extracted information on seven studies.
Traditional meta-analysis (TMA) was used to compare each anti-TNF agent to placebo.
Bayesian network meta-analysis (NMA) was performed to compare the effects of anti-TNF agents to placebo.
|Infliximab is effective for remission in ulcerative colitis|
|Alimentary Pharmacology & Therapeutics|
In addition, sample sizes for comparative efficacy trials were calculated.
Compared to placebo, the team noted that TMA revealed that anti-TNF agents result in a higher likelihood of induction of remission and response as well as maintenance of remission and response.
The researchers found that individually, infliximab, adalimumab and goliumumab resulted in a higher likelihood of induction and maintenance for both remission and response.
NMA found nonsignificant trends in comparisons of the individual agents.
The team noted that required sample sizes for direct head-to-head trials between infliximab and adalimumab for induction and maintenance are 174 and 204 subjects, respectively.
Dr Waljee's team concludes, "This study demonstrates that, compared to placebo, infliximab, adalimumab and golimumab are all effective for the induction and maintenance of remission in ulcerative colitis."
"However, network meta-analysis demonstrates that no single agent is clinically superior to the others and therefore, other factors such as cost, safety, route of administration and patient preference should dictate our choice of anti-TNF agents."
"A randomized comparative efficacy trial between infliximab and adalimumab in ulcerative colitis is of practical size and should be performed."