Biologics for treatment of moderately to severely ulcerative colitis:a network meta-analysis on the effectiveness and safety of maintenance therapy
Objective To employ a network meta-analysis comparing the effectiveness and safety of different biologic agents in patients with moderately to severely ulcerative colitis during the maintenance therapy period.Methods RCTs were searched in CNKI,Wanfang Data,VIP,China Biology Medicine disc,PubMed,the Cochrane Library,and Embase databases from their inception to July,2023.Relevant studies on biologics for the treatment of ulcerative colitis were collected.A net-work meta-analysis was performed using RevMan 5.3 and Stata 16.0 software after screening the literature according to the in-clusion and exclusion criteria,evaluating the quality of the studies and extracting data.Results A total of 1374 articles were re-trieved from various databases and 17 articles were included with 18 RCTs and totaled sample size of 5939 cases.There was a total of 10 intervention methods,including 7 medications.They were as follows:placebo,infliximab intravenous injection,adalimumab subcutaneous injection,vedolizumab intravenous injection,vedolizumab subcutaneous injection,golimumab subcutaneous injection,ustekinumab subcutaneous injection once every 8 weeks,ustekinumab subcutaneous injection once every 12 weeks,etrolizumab subcutaneous injection,mirikizumab subcutaneous injection.The meta results showed that differ-ent medication regimens had different performances in terms of efficacy indicators.Considering endoscopic mucosal healing and overall adverse events,it was found that vedolizumab subcutaneous injection not only provided good mucosal healing effi-cacy but also had the least incidence of adverse events followed by vedolizumab intravenous injection and mirikizumab subcu-taneous injection.Conclusion There are three main pathways of biologics for the treatment of ulcerative colitis,of which the integrin antagonist vedolizumab excels in efficacy and safety and is available in both subcutaneous and intravenous dosage forms for clinical selection.The interleukin inhibitor mirikizumab can be used as a second choice.
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