Digestive Disease Week 2015
DDW 2015. Sa1254. Biologic Therapies are Effective in Inducing and Maintaining Mucosal Healing in Ulcerative Colitis: A Systematic Review & Meta-Analysis.
Michael J. Stewart(1), Ahmed Al-Darmaki(1), Remo Panaccione(1), Gilaad Kaplan(1,2), Cynthia H. Seow(1)
1. Medicine, University of Calgary, Calgary, Alberta, Canada; 2. Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Results: Thirty-five trials were identified and 13 met the inclusion criteria. Of trials using an anti-TNFα, 6 were induction trials totalling over 2000 patients and 3 were maintenance trials totalling over 1500 patients. Anti-TNFα versus placebo increased both induction and maintenance of MH (RR=1.26; 95% CI, 1.07-1.50, and RR=1.68; 95% CI, 1.43-1.97, respectively). The use of an anti-adhesion molecule was evaluated in 3 induction trials, totalling over 1000 patients, and a maintenance trial with over 350 patients. Anti-adhesion molecule versus placebo also increased both induction and maintenance of MH (RR=1.57; 95% CI, 1.19-2.07, and RR=2.71; 95% CI, 1.88-3.93, respectively). Induction of remission was evaluated using an anti-CD20, anti-CD3, and anti-IL2 receptor antibody in 1 trial each. The use of biologic therapy was associated with a decreased risk of study withdrawal due to adverse events for both anti-TNFα (RR=0.65; 95% CI, 0.48-0.86) as well anti-adhesion molecule biologic therapies (RR=0.33; 95% CI, 0.10-1.16).
Conclusions: Biologic therapies are more effective in inducing and maintaining MH than placebo in patients with UC. The effect is seen using both anti-TNFα and anti-adhesion molecule biologic therapies. Both classes of therapies were well tolerated with minimal adverse effects.
CARE Faculty Perspective:
The end goal of treatment for ulcerative colitis has shifted from symptomatic control to achieving mucosal healing. Those who achieve mucosal healing have lower rates of relapses, steroid use, hospitalization and surgery. This systematic review of the efficacy of several biologic therapies in inducing/maintaining mucosal healing determined that biologic therapies are more effective than anti-TNF and anti-adhesion molecule biologic therapies, with less adverse effects.
- CARE Gastroenterology Faculty