Mucosal healing is an important therapeutic endpoint in the management of Crohn's disease, and ulcerative colitis.
Limited data exist regarding the comparative efficacy of various therapies in achieving this outcome.
Dr Ananthakrishnan and colleagues from Massachussetts, USA performed a systematic review and meta-analysis of biologics for induction and maintenance of mucosal healing in Crohn's disease and ulcerative colitis.
The researchers performed a systematic review and meta-analysis of randomized controlled trials examining mucosal healing as an endpoint of immunosuppressives, anti-tumor necrosis factor α (anti-TNF) or anti-integrin monoclonal antibody therapy for moderate-to-severe Crohn's disease or ulcerative colitis.
The team calculated pooled effect sizes for induction and maintenance of mucosal healing, and evaluated pairwise treatment comparisons using a Bayesian network meta-analysis.
|Adalimumab therapy was inferior to infliximab for inducing mucosal healing in ulcerative colitis|
|Alimentary Pharmacology & Therapeutics|
The research team included a total of 12 randomized controlled trials in the meta-analysis.
Duration of follow-up was 6–12 weeks for induction and 32-54 weeks for maintenance trials.
In Crohn's disease, the team found that anti-TNFs were more effective than placebo for maintaining mucosal healing.
In ulcerative colitis, the researchers observed that anti-TNFs and anti-integrins were more effective than placebo for inducing, and maintaining mucosal healing.
In network analysis, adalimumab therapy was inferior to infliximab, and combination infliximab-azathioprine for inducing mucosal healing in ulcerative colitis.
The research team observed that there was no statistically significant pairwise difference between vedolizumab and anti-TNF agents in ulcerative colitis.
Dr Ananthakrishnan's team concludes, "Anti-TNF and anti-integrin biological agents are effective in inducing mucosal healing in ulcerative colitis, with adalimumab being inferior to infliximab or combination therapy."
"Infliximab and adalimumab were similar in Crohn's disease."