Journal Article

AB1505 THE COMPARISON OF THE EFFICACY OF INTERLEUKIN (IL)-23 TARGETED DRUGS IN THE TREATMENT OF CROHN'S DISEASE: A BAYESIAN NETWORK META-ANALYSIS

Gao, Y.L., Ren, J.Y., Yu, Q., Li, X., Zhou, H., Su, Q.Y., He, P.F., Liu, Y.X., Shen, R.T., Xia, G.M., Zhang, R.Y., Zhang, S.X., Shi, W.F.

2023

Overview

Crohn's disease (CD) is a chronic inflammatory disease of unknown etiology. The IL-23/IL-17 pathway plays an essential role in the pathogenesis of CD. More and more approved IL-23 inhibitors are being used for the treatment of CD. However, no studies have systematically compared and evaluated the efficacy of these IL-23 inhibitors. This study aims to compare the efficacy of various IL-23 inhibitors(Brazikumab, Guselkumab, Mirikizumab, Risankizumab, and Ustekinumab) for treating Crohn's disease by conducting a Bayesian network meta-analysis (NMA). We searched the database, including PubMed, Embase, Web of Science, Cochrane Library, MEDLINE, and Web of Science, Clinical Trials. gov, (from inception until February 5, 2023). Efficacy (Clinic response, Clinic remission, Endep remission, and C-reactive protein) were compared using a Bayesian NMA. Results were presented as the pooled estimates of odds ratios (ORs) or weighted mean difference (WMD) (95% CI). The random-effects model was selected to synthesize the data. The ranking probability for each IL-23 inhibitor was evaluated using the surface under the cumulative ranking curves (SUCRA). The larger the SUCRA value, the better the rank of the intervention. The global inconsistency was evaluated by comparing the fit of consistency and inconsistency models, where P ≤ 0.05 indicated inconsistency. All analyses were conducted using the gemtc package of R (version 4.2.2). In terms of Clinic response, a total of 40 studies were included. The NMA showed that Brazikumab combined with Guselkumab [OR=-0.98, 95% (CI, -2.9, 0.91)], PBO(PBO) combined with Risankizumab [OR=-0.54, 95% (CI, -1.16, 0.18)], PBO combined with Ustekinumab [OR=-1.38, 95% (CI, -2.77, -0.01)], Risankizumab combined with Ustekinumab [OR=-0.84, 95% (CI, -2.43, 0.63)]. According to SUCRA, Ustekinumab (78.9%), Risankizumab (52.2%), PBO(23.6%), Mirikizumab(34%), Guselkumab (87.6%), and Brazikumab (23.6%). For clinic remission, the result of NMA showed that Brazikumab combined with Guselkumab [OR=-1.59, 95% (CI, -3.78, 0.59)], Brazikumab combined with Ustekinumab [OR=-1.37, 95% (CI, -3.57, 0.83)], PBO combined with Risankizumab [OR=-0.47, 95% (CI, -1.19, 0.34)], PBO combined with Ustekinumab [OR=-1.26, 95% (CI, -2.86, 0.33)], Risankizumab combined with Ustekinumab [OR=-0.8, 95% (CI, -2.6, 0.93)]. According to SUCRA, Ustekinumab (79.3%), Risankizumab (53.7%), PBO(22.1%), Mirikizumab(33.4%), Guselkumab (90.3%)and Brazikumab (21.7%) (Figure 1). In terms of efficacy alone, Guselkumab ranked first among all IL-23 inhibitors, followed by Ustekinumab, and all had significantly different clinical remission rates than patients in the PBO group, while the remaining drugs were less effective than PBO. [Display omitted] NIL. NIL. None Declared.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Bayesian analysis / C-reactive protein / Clinical trials / Crohn's disease / Inflammatory bowel diseases / Interleukin 17 / Interleukin 23 / Mathematical models / Meta-analysis / Monoclonal antibodies / Remission / Remission (Medicine) / Systematic review, Gastrointestinal tract