Comparative efficacy and safety of biologic therapies for moderate-to-severe Crohn's disease: a systematic review and network meta-analysis

Review found that for biological-naïve patients (15 RCTs; n=2931), infliximab (IFX) plus azathioprine or adalimumab had highest odds of inducing remission; for second-line therapy (10 RCTs; n=2479) adalimumab (after IFX loss of response) or risankizumab might be preferred.

SPS commentary:

The key findings were as follows:

  • In biologic-naive patients, when compared to certolizumab pegol, infliximab monotherapy (OR 4.53; 95% CI 1.49–13.79]), infliximab plus azathioprine (7·49; 2.04–27.49), adalimumab (3.01; 1.25–7.27), and ustekinumab (2.63; 1.10–6.28) were associated with higher odds of inducing remission. In addition, infliximab plus azathioprine was also associated with significantly higher odds of inducing remission than vedolizumab (3.76 [1.01–14.03; low confidence).

 

  • In patients with previous biologic exposure, when compared to vedolizumab, adalimumab (after loss of response to infliximab; 2.82 [1.20–6.62]; low confidence), and risankizumab (2.10; 1.12–3.92; moderate confidence), were associated with higher odds of inducing remission.

The authors stress that biological treatment choices in this setting must be individualised for each patient.

The Lancet Gastroenterology and Hepatology

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