Biologic therapy, small molecules induce remission in ulcerative colitis
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Compared with placebo, most biologic and small molecule therapies correlated with superiority for the induction of remission in moderate to severe ulcerative colitis, according to research published in Gut.
“Over the last 20 years novel drugs, with more precise modes of action, based on mechanisms of disease identified in genome wide association studies, have been developed. ... In the last 10 years, small molecules, which can be administered orally and on a daily basis, have also been evaluated in moderate to severe UC,” Nicholas E. Burr, MBBS, MRCP, of the Mid Yorkshire Hospitals NHS Trust and Leeds Gastroenterology Institute, and authors wrote. “However, this is a rapidly moving field, and there are already several newer drugs that have shown efficacy in phase 3 clinical trials that were not considered in these network meta-analyses.”
In an updated network meta-analysis, researchers aimed to evaluate the efficacy of biological therapies and small molecules for the induction of remission, endoscopic improvement and clinical response among 12,504 patients from 12 phase 3 trials with moderate to severe UC. They further stratified the patient population according to previous exposure to antitumor necrosis factor therapy. Pooled RRs reported data.
According to study results, upadacitinib 45 mg once daily ranked first for clinical remission compared with placebo (RR = 0.73; 95% CI, 0.68-0.8) among both anti-TNF naive patients (RR = 0.69; 95% CI, 0.61-0.78) as well as patients previously exposed to anti-TNF therapy (RR = 0.78; 95% CI, 0.72-0.85). Infliximab 5 mg/kg and infliximab 10 mg/kg followed. Based on endoscopic improvement, infliximab 10 mg/kg ranked first (RR = 0.61; 95% CI, 0.51-0.72) followed by upadacitinib 45 mg once daily then infliximab 5 mg/kg. Researchers noted tofacitinib correlated with a higher likelihood for infection compared with placebo (RR = 1.41; 95% CI, 1.03-1.91).
“In summary, this systematic review and network meta-analysis has demonstrated that all biological therapies and small molecules, other than adalimumab 160/160 mg, adalimumab 80/40 mg and filgotinib 100 mg once daily, were superior to placebo for induction of remission of moderate to severe UC, and all drugs, other than adalimumab 80/40 mg, were superior to placebo in terms of endoscopic improvement,” Burr and colleagues concluded.
“Future trials should better elucidate the impact of these drugs on long-term and corticosteroid-free clinical remission in patients with moderate to severe UC.”
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