Review finds upadacitinib most effective for moderate to severe ulcerative colitis remission
The systematic review and meta-analysis of biologic and small-molecule drugs for patients with moderate to severe ulcerative colitis also found that upadacitinib ranked highest for adverse events, whereas vedolizumab had the lowest rate of adverse events and serious adverse events.
A review of biologic and small-molecule drugs for patients with moderate to severe ulcerative colitis found that upadacitinib was the most effective but also had the most adverse effects.
The systematic review and network meta-analysis included 29 studies published between Jan. 1, 1990, and July 1, 2021 (of these, four were head-to-head randomized controlled trials). Twenty-three studies assessed induction therapy with either a biologic or small-molecule drug in a total of 10,061 patients with ulcerative colitis. Most of the studies appeared to have low risk of bias. Results were published by The Lancet Gastroenterology & Hepatology on Nov. 29.
The analysis found upadacitinib to be significantly superior to all the other treatments for the primary outcome of induction of clinical remission, with odds ratios of 2.70 (95% CI, 1.18 to 6.20) versus infliximab, 4.64 (95% CI, 2.47 to 8.71) versus adalimumab, 3.00 (95% CI, 1.32 to 6.82) versus golimumab, 3.56 (95% CI, 1.84 to 6.91) versus vedolizumab, 2.92 (95% CI, 1.31 to 6.51) versus ustekinumab, 4.91 (95% CI, 2.59 to 9.31) versus etrolizumab, 2.84 (95% CI, 1.28 to 6.31) versus tofacitinib, 6.15 (95% CI, 2.98 to 12.72) versus 100 mg of filgotinib, 4.49 (95% CI, 2.18 to 9.24) versus 200 mg of filgotinib, and 2.70 (95% CI, 1.18 to 6.20) versus ozanimod.
No significant differences in adverse events and serious adverse events were observed between the active interventions, but vedolizumab ranked lowest for both adverse events and serious adverse events. Upadacitinib ranked highest for adverse events, and ozanimod ranked highest for serious adverse events. The study authors concluded that upadacitinib was the best-performing agent for the induction of clinical remission but the worst performing for adverse events. Limitations of the study include that the drugs were indirectly compared, so the results should be interpreted with caution “but could help clinicians to navigate the current scenario in which the number of therapeutic options for moderate-to-severe ulcerative colitis is steadily increasing,” the study authors said.
An accompanying editorial comment took from the study that small-molecule drugs are poised to “transform ulcerative colitis care,” although safety signals remain a problem. “It is not likely that a single, definitive, first-line agent of choice for moderate-to-severe ulcerative colitis will emerge, nor will there be a one-size-fits-all therapeutic sequence,” the editorialists wrote, concluding that “we are just scratching the surface of being able to decide the right treatment for the right patient at the right time.”