Mild-moderate UC: meta-analysis identifies top drugs for induction, maintenance of remission

  • Nguyen NH & al.
  • Lancet Gastroenterol Hepatol
  • 16 Aug 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • For induction of remission in mild to moderate ulcerative colitis (UC), the 2 top-ranked drugs are combined oral/rectal 5-aminosalicylates (5-ASAs) and high-dose (>3 g/day) mesalazine, according to a network meta-analysis.
  • For maintenance of remission, standard-dose mesalazine (2-3 g/day) is preferred.

Why this matters

  • ~80% of patients with UC have mild to moderate disease.
  • Findings from this first network meta-analysis to compare all pharmacologic interventions should be used to inform clinical practice guidelines.

Study design

  • Network meta-analysis of 75 randomized controlled trials (n=12,215) that met eligibility criteria after a search of >8 databases.
  • Interventions were sulfasalazine, diazo-bonded and combined oral/rectal 5-ASAs, mesalazine at 3 different doses, and budesonide alone or in combination with another agent.
  • Interventions were ranked using surface under the cumulative ranking (SUCRA) probabilities.
  • Funding: None.

Key results

  • Induction of remission:
    • Combined oral/rectal 5-ASAs (SUCRA, 0.99) and high-dose mesalazine (SUCRA, 0.82) were ranked highest on efficacy, whereas high- and standard-dose mesalazine were better tolerated than budesonide and sulfasalazine.
    • Combined oral/rectal 5-ASAs and high-dose mesalazine were superior to standard-dose mesalazine on failure to induce remission (OR, 0.41 [95% CI, 0.22-0.77] and 0.78 [95% CI, 0.66-0.93], respectively).
  • Maintenance of remission:
    • Combined oral/rectal 5-ASAs (SUCRA, 0.82), high-dose mesalazine (SUCRA, 0.82), and standard-dose mesalazine (SUCRA, 0.69) ranked highest on efficacy, whereas standard-dose mesalazine was among the best-tolerated (SUCRA, 0.73).

Limitations

  • Heterogeneity across studies.

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