According to a network meta-analysis, the top-ranked drugs to treat luminal Crohn’s disease depend on the patient’s disease status.
In a trial involving 12,736 patients with luminal Crohn’s disease in a pooled analysis of 40 people, a 5 mg/kg dose of infliximab (Remicade) was associated with a reduction in all ranked first in terms of risk of clinical remission failure, while risankizumab (Skyrizi) at 600 mg ranked second, and upadacitinib (Rinvoq) at 45 mg once daily compared to placebo ranked third:
- Infliximab: Composite Relative Risk (RR) 0.67 (95% CI 0.56-0.79)
- Risankizumab : RR 0.73 (95% CI 0.66-0.80)
- Upadacitinib: RR 0.75 (95% CI 0.68-0.83)
But when it comes to biological exposure history, the same dose of risankizumab ranked first in lowering those receiving (RR 0.74, 95% CI 0.67-0.82) or not receiving prior biological therapy (RR 0.66, 95% CI 0.52-0.85) risk of clinical remission failure in patients, reportd Alexander Ford, MD, Leeds Teaching Hospitals NHS Trust, UK, and colleagues.
For maintenance of remission, upadacitinib at a once-daily dose of 30 mg was associated with a lower risk of disease recurrence (RR 0.61, 95% CI 0.52-0.72) followed by 40 weekly Adalimumab (Humira) at a mg dose and infliximab at a 8-week dose of 10 mg/kg.
“Nevertheless, blanket application of the results of this meta-analysis should be avoided,” the group said in Gut. “Treatment selection should be based on these results as well as patient choice, which may be influenced by other considerations, including route and convenience of administration, and likelihood of compliance, and cost of health services.”
Experts who spoke with MedPage Today said the analysis should be interpreted with caution.
Russell Cohen, MD, of the University of Chicago School of Medicine, who was not involved in the study, called the analysis a “useful summary” but argued that “until an appropriate face-to-face trial is conducted In doing so, insurance companies or public officials should not use the information from meta-analyses alone to guide treatment interventions for Crohn’s disease.”
Stephen Hanauer, Northwestern University, Chicago Hanauer, MD, who was also not involved in the study, added that the level of evidence provided by the network meta-analysis was low.
“There are newer therapies ng for patients with Crohn’s disease with higher tissue specificity, such as interleukin-23 blockers, with more systemic and larger infections risk of older TNF [tumor necrosis factor] blockers may offer greater efficacy and safety,” he told MedPage Today.
Ford and colleagues examined data from 25 induction trials (n=8,720) and 15 maintenance trials (n=4,016) involving patients with moderate to severe intraluminal Adults with Ron’s disease.
When studying biologics, vedolizumab (Entyvio) at a dose of 108 mg twice weekly appeared first in maintenance therapy—especially for those who had previously received those who received biologics (RR 0.70, 95% CI 0.57-0.86) — and the 40 mg weekly adalimumab dose ranked first among those who had not received biologics (RR 0.59, 95% CI 0.48- 0.73).
In all induction and remission trials, no drug was associated with a greater risk of adverse events (AEs), serious AEs, or infections compared with placebo. However, more maintenance patients who received the 10 mg/kg dose of infliximab for 8 weeks discontinued due to AEs.
Study limitations included the fact that only 20 trials were at low risk of factual bias. In addition, the three upadacitinib trials (U-EXCEED, U-EXCEL, and U-ENDURE) have not been fully published, with no data on prior biological exposure.
Zaina Hamza is a staff writer for Medicine Today covering gastroenterology and infectious diseases. She is based in Chicago.
Ford and co-authors disclose no industry affiliation.