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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Gastrointestinal and Hepatic Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1475222
This article is part of the Research Topic Reviews in Gastrointestinal and Hepatic Pharmacology: 2024 View all 4 articles

Systematic Review and Bayesian Network Meta-Analysis: Comparative Efficacy and Safety of Six Commonly Used Biologic Therapies for Moderate-to-Severe Crohn's Disease

Provisionally accepted
Haohang Su Haohang Su 1,2Shengwei Xiao Shengwei Xiao 1Tianrong Xun Tianrong Xun 1Xixiao Yang Xixiao Yang 1,3*
  • 1 Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, China
  • 2 School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
  • 3 Shenzhen Clinical Research Center for Digestive Disease, Shenzhen, China

The final, formatted version of the article will be published soon.

    In contrast to previous network meta-analysis using classical frequentist methods, we evaluated the efficacy and safety of six frequently-used biologics through a Bayesian method.Methods: Web of Science, Scopus, CENTRAL, ClinicalTrials.gov and ICTRP were searched to collect randomized controlled trials (RCTs) in adults with moderate-to-severe Crohn's disease, comparing Infliximab, Adalimumab, Certolizumab pegol, Ustekinumab, Risankizumab, or Vedolizumab, relative to placebo or an active comparator for induction of clinical response (two different definitions) and maintenance of clinical remission. A random-effects model was performed with rankings according to the surface under cumulative ranking curve (SUCRA) probability. Finally, we completed sensitivity and consistency analyses, and evaluated the certainty of evidence through GRADE working group guidance.We identified 22 and 20 RCTs for induction and maintenance therapy, respectively. Infliximab combined with azathioprine was most effective for inducing clinical response in TNF (tumor necrosis factor) antagonist-naï ve patients. For TNF antagonist-experienced patients, Ustekinumab (SUCRA 86.19) and Risankizumab (SUCRA 62.56) have the largest SUCRA in induction of clinical response. Risankizumab has the lowest risk of adverse events (SUCRA 84.81), serious adverse events (SUCRA 94.23), and serious infections (SUCRA 79.73) in induction therapy. Adalimumab and the 10 mg/kg regimen of Infliximab rank highest for maintaining clinical remission.Conclusions: This analysis suggests that Infliximab in combination with azathioprine may be preferred biologic agents for induction therapy in TNF antagonist-naï ve patients. For TNF antagonist-experienced patients, Ustekinumab and Risankizumab may be preferred biologic agents for induction therapy. Risankizumab potentially has the lowest safety risk worth exploring in induction therapy. Adalimumab and the 10 mg/kg regimen of Infliximab have maintenance efficacy benefits for responders to induction therapy.

    Keywords: Bayesian network meta-analysis, Crohn's disease, Biologic agents, efficacy, Safety, Grade

    Received: 09 Oct 2024; Accepted: 10 Dec 2024.

    Copyright: © 2024 Su, Xiao, Xun and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xixiao Yang, Department of Pharmacy, Shenzhen Hospital, Southern Medical University, Shenzhen, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.