Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis

Abstract Background:Therapeutic options for ulcerative colitis (UC) have increased since the introduction of biologics a few decades ago. Due to the wide range of biologics available, physicians have difficulty in selecting biologics and do not know how to balance the best drug between clinical efficacy and safety. This study aimed to compare the efficacy and safety of biologics in treating ulcerative colitis. Methods: In this study, eight electronic databases (PubMed, Web of Science, Cochrane, Embase, Sinomed, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data) were searched to collect eligible studies without language restrictions. Retrieved 6 September 2022, from inception. All articles included in the mesh analysis are randomised controlled trials (RCTs). The inclusion of drugs for each outcome was ranked using a curved surface under cumulative ranking (SUCRA). Higher SUCRA scores were associated with better outcomes, whereas lower SUCRA scores were associated with better safety. This study has registered with PROSPERO, CRD42023389483. Results: A total of 25 RCTs, including 7595 patients, were included in this network meta-analysis. PF-00547659 ranked the highest in clinical remission among pure biologics (SUCRA 73.6%) and also ranked third in mucosal healing (SUCRA 74.1%), while adalimumab ranked highest in clinical response (SUCRA 94.9%). Infliximab ranked highest in endoscopy improvement (SUCRA 83.9%). BMS-936557 ranked second lowest in terms of adverse events (30.8% SUCRA) and severe adverse events (20.5% SUCRA). Conclusion: By indirect comparison, PF-00547659, adalimumab and infliximab were effective biological agents in UC patients. Further studies are required to evaluate their short- and long-term efficacy and safety.