Network Meta-analysis of efficacy and safety of drugs for the treatment of moderate to severe ulcerative colitis

Abstract

Abstract Purpose There are many kinds of drugs for the treatment of moderate to severe UC, but the number of "head-to-head" clinical trials between these drugs is very limited. There is no reliable evidence to guide the selection of drugs. The purpose of this study is to evaluate the efficacy and safety of drugs for the treatment of moderate to severe UC used network meta-analysis. Methods We searched the Embase, PubMed, The Cochrane Library, and Web of Science databases from inception to March 31, 2023. According to strict inclusion and exclusion criteria, we included randomized controlled trials (RCTs) about aminosalicylic acid, hormones, immunosuppressants, biological agents, and small molecule drugs used alone or in combination in the treatment of UC. We used Stata17.0 software for statistical analysis and results were reported as relative risk (RR) and 95% confidence interval (CI). Results A total of 18 articles (22 RCTS in total) were included, including 7873 patients with moderate to severe UC. For the efficacy outcomes, Upadacitinib is ranked first in induction of clinical response with 96.0% cumulative probability. Upadacitinib is ranked first in induction of clinical remission with 99.3% cumulative probability. Upadacitinib is ranked first in induction of endoscopic improvement with 99.0% cumulative probability. Upadacitinib is ranked first in maintenance of clinical remission with 93.2% cumulative probability. Upadacitinib is ranked first in maintenance of endoscopic improvement with 93.3% cumulative probability. For the safey outcomes, Vedolizumab is the best in incidence of AE with 16.8% cumulative probability. Upadacitinib is the best in incidence of SAE with 13.8% cumulative probability. Conclusions Upadacitinib may have the best efficacy during the induction and maintenance periods, with the lowest SAE rate, and be the most comprehensively effective intervention. Vedolizumab may have the best safety. Infliximab combined with AZA may improve efficacy and reduce safety.