Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 6044-6051
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.6044
Infliximab is superior to other biological agents for treatment of active ulcerative colitis: A meta-analysis
Wei-Qun Mei, Hui-Zhen Hu, Ying Liu, Zhi-Chen Li, Wei-Guo Wang
Wei-Qun Mei, Hui-Zhen Hu, Wei-Guo Wang, Department of Gastroenterology, No. 117 Hospital of PLA, Hangzhou 310021, Zhejiang Province, China
Ying Liu, Zhi-Chen Li, Department of Endocrinology, No. 117 Hospital of PLA, Hangzhou 310021, Zhejiang Province, China
Author contributions: Wang WG designed the study; Mei WQ and Hu HZ screened the citations; Mei WQ and Liu Y performed the data analyses; Li ZC wrote the paper.
Conflict-of-interest: The authors declare that there is no conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Wei-Guo Wang, Department of Gastroenterology, No. 117 Hospital of PLA, No. 40 Jichang Road, Hangzhou 310021, Zhejiang Province, China. wangweiguo117@126.com
Telephone: +86-571-87340801 Fax: +86-571-87340811
Received: September 24, 2014
Peer-review started: September 25, 2014
First decision: October 29, 2014
Revised: November 25, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: May 21, 2015
Processing time: 238 Days and 1.2 Hours
Abstract

AIM: To compare the efficacy and safety of biological agents for the treatment of active ulcerative colitis (UC).

METHODS: PubMed, MEDLINE, EMBASE and the Cochrane library were searched to screen relevant articles from January 1996 to August 2014. The mixed treatment comparison meta-analysis within a Bayesian framework was performed using WinBUGS14 software. The proportions of patients reaching clinical response, clinical remission and mucosal healing in induction and maintenance phases were analyzed as efficacy indicators. Serious adverse events in maintenance phase were analyzed as safety indicators.

RESULTS: The meta-analysis results showed that biological agents achieved better clinical response, clinical remission and mucosal healing than placebo. Indirect comparison indicated that in induction phase, infliximab was more effective than adalimumab in inducing clinical response (OR = 0.41, 95%CI: 0.29-0.57), clinical remission (OR = 0.33, 95%CI: 0.19-0.56) and mucosal healing (OR = 0.33, 95%CI: 0.19-0.56), and golimumab in inducing clinical response (OR = 0.66, 95%CI: 0.39-2.33) and mucosal healing (OR = 2.15, 95%CI: 1.18-4.22). No significant difference was found between placebo and biological agents regarding their safety.

CONCLUSION: All biological agents were superior to placebo for UC treatment in both induction and maintenance phases with a similar safety profile, and infliximab had a better clinical effect than the other biological agents.

Keywords: Biological agents; Drug safety; Efficacy; Meta-analysis; Ulcerative colitis

Core tip: Currently the selection of biological agents in ulcerative colitis (UC) therapy is still controversial. We performed this meta-analysis to compare the efficacy and safety of biological agents for the treatment of active UC, and finally found that all biological agents were superior to placebo for UC treatment in both induction and maintenance phases with a similar safety profile, and infliximab had a better clinical effect than the other biological agents.