Comparative Efficacy of Subcutaneous and Intravenous Infliximab and Vedolizumab for Maintenance Treatment of TNF-naive Adult Patients with Inflammatory Bowel Disease: A Systematic Literature Review and Network Meta-analysis

• Published in: Digestive diseases and sciences 2024-05, Vol.69 (5), p.1808-1825
• Main Authors: Peyrin-Biroulet, L., Bossuyt, P., Bettenworth, D., Loftus, E. V., Anjie, S. I., D’Haens, G., Saruta, M., Arkkila, P., Park, H., Choi, D., Kim, D- H., Reinisch, W.
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adult; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - therapeutic use; Biochemistry; Colitis, Ulcerative - drug therapy; Crohn Disease - drug therapy; Crohn's disease; Endoscopy; Gastroenterology; Gastrointestinal Agents - administration & dosage; Gastrointestinal Agents - therapeutic use; Hepatology; Humans; Infliximab - administration & dosage; Infliximab - therapeutic use; Injections, Subcutaneous; Literature reviews; Maintenance Chemotherapy - methods; Medicine; Medicine & Public Health; Meta-analysis; Network Meta-Analysis; Oncology; Original; Original Article; Randomized Controlled Trials as Topic; Remission (Medicine); Remission Induction; Systematic review; Transplant Surgery; Treatment Outcome
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-023-08252-1

Background Infliximab and vedolizumab are widely used to treat Crohn’s disease (CD) and ulcerative colitis (UC). Aims This systematic review and network meta-analysis evaluated comparative efficacy of various regimens for intravenous or subcutaneous infliximab and vedolizumab during maintenance treatment in CD and UC. Methods Parallel-group randomized controlled trials (RCTs) were identified by a systematic literature review (CRD42022383401) and included if they evaluated therapeutics of interest for maintenance treatment of adults with moderate-to-severe luminal CD or UC and assessed clinical remission between Weeks 30 and 60. Clinical remission rates in CD or UC and mucosal healing rates in UC were analyzed in a Bayesian network meta-analysis model. Endoscopic outcomes in CD were synthesized by proportional meta-analysis. Results Overall, 13 RCTs were included in the analyses. All vedolizumab studies randomized induction responders to maintenance treatment; infliximab studies used a treat-through design. Subcutaneous infliximab 120 mg every 2 weeks had the highest odds ratio (OR) [95% credible interval] versus placebo for clinical remission during the maintenance phase (CD: 5.90 [1.90–18.2]; UC: 5.45 [1.94–15.3]), with surface under the cumulative ranking curve (SUCRA) values of 0.91 and 0.82, respectively. For mucosal healing in UC, subcutaneous infliximab 120 mg every 2 weeks showed the highest OR (4.90 [1.63–14.1]), with SUCRA value of 0.73, followed by intravenous vedolizumab 300 mg every 4 weeks (SUCRA value, 0.70). Endoscopic outcomes in CD were better with subcutaneous infliximab 120 mg every 2 weeks than intravenous infliximab 5 mg/kg every 8 weeks. Conclusions Subcutaneous infliximab showed a favorable efficacy profile for achieving clinical remission and endoscopic outcomes during maintenance treatment in CD or UC. Graphical Abstract