Biological therapies have improved the care of patients with ulcerative colitis (UC).
Tofacitinib, an oral small-molecule Janus kinase inhibitor, is potentially a new treatment option.
Dr Bonovas and colleagues from Italy comparatively assessed efficacy and harm of tofacitinib and biologics in adult patients not previously exposed to TNF antagonists.
The team performed a comprehensive search of PubMed, Embase, Scopus, clinical trial registries, regulatory authorities' websites and major conference proceedings, through 2017, to identify randomized, placebo-controlled or head-to-head trials assessing tofacitinib or biologics as induction and/or maintenance therapy in moderate-to-severe UC.
There were 2 reviewers independently extracted study data and outcomes, and investigated each trial's risk-of-bias.
|Tofacitinib and biologics are efficacious and safe for UC|
|Alimentary Pharmacology & Therapeutics|
The team used conventional meta-analysis to synthesise direct evidence, and network meta-analysis for adjusted indirect treatment comparisons.
The researchers identified 15 randomized, double-blind, placebo-controlled trials contributed data for induction.
The team observed that all treatments are superior to placebo.
Indirect treatment comparisons showed that infliximab is better than adalimumab and golimumab in clinical response, better than adalimumab in clinical remission, and better than adalimumab and golimumab in mucosal healing. No indirect comparisons between tofacitinib and biologics reached statistical significance.
The researchers found 9 studies that contributed maintenance data showing that all treatments have higher clinical efficacy than placebo.
Safety analyses indicated no increased rates of adverse events for the treatments under evaluation, while vedolizumab may have an advantage regarding the occurrence of serious adverse events.
Dr Bonovas' team concludes, "Tofacitinib and biologics are efficacious and safe for UC."
"Further high-quality research is warranted to establish the best therapeutic option."