Su1134 Comparative Efficacy of Biologic Therapy in the Management of Biologic-Naive Patients With Ulcerative Colitis: An Indirect Treatment Comparison Meta-Analysis

Abstract

S-384 AGA Abstracts are primarily driven by insurance coverage and patient preference. In the absence of headto-head clinical trials, we sought to estimate the comparative efficacy of biologic therapy in the management of biologic-Naive patients with UC through an indirect treatment comparison networkmeta-analysis of randomized controlled trials (RCTs).Methods: Through a systematic search of multiple databases through September 2013, we identified RCTs in adults with UC comparing biologic therapy (infliximab [IFX], adalimumab [ADA], golimumab [GLM] and vedolizumab [VEDO]) to each other or placebo, in inducing and maintaining clinical remission in UC. We extracted data on efficacy in a subset of biologic-Naive patients to allow a homogenous comparison. We conducted traditional random effect meta-analyses to estimate the direct effect and then conducted network meta-analysis to combine direct and indirect estimates, expressed as odds ratio (OR) with 95% confidence intervals (CI). Results: We identified 9 clinical trials assessing efficacy of biologic therapy in inducing remission in UC, with all trials comparing treatment against only placebo. On direct comparison, both anti-TNF agents and VEDO were more effective than placebo. On indirect comparison, no single agent was superior to others. Although patients on IFX were almost twice as likely to achieve induction of remission than those on ADA (IFX v. ADA: OR, 1.9; 95% CI, 0.84.6), this difference was not statistically significant (p=0.17). Similarly, patients on ADA were 40% less likely to achieve induction of clinical remission than those on GLM (ADA v. GLM: OR, 0.6; 95% CI, 0.3-1.2), but this difference was also not statistically significant (p=0.18) (Table 1). A non-significant trend was observed suggesting that IFX may be more efficacious than ADA in inducing mucosal healing (IFX v. ADA: OR, 2.0; 95% CI, 0.974.3, p=0.06) IFX appeared superior to ADA, GLM and VEDO in maintaining remission (and maintaining mucosal healing) in patients with UC; however, due to differences in trial design, comparability was limited (Table 2). Conclusions: Based on indirect treatment comparison, IFX, ADA, GLM and VEDO had comparable efficacy, with no agent being clearly superior to others. There was a non-significant trend suggesting that IFX may be superior to ADA in inducing mucosal healing in anti-TNF Naive patients with UC. However, in the absence of head-to-head treatment comparison, confidence in these estimates is low. Future head-to-head treatment comparison trails and comparative effectiveness observational studies in a homogenous cohort are warranted. Comparative Efficacy of Biologic Therapy in Inducing Remission in UC