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

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2024 Mar 19

PMID 38499736

Authors

L Peyrin-Biroulet

P Bossuyt

D Bettenworth

E V Loftus Jr

S I Anjie

G DHaens

M Saruta

P Arkkila

H Park

D Choi

D- H Kim

W Reinisch

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Switching to Subcutaneous Infliximab Maintenance Therapy Is Effective in Patients with Inflammatory Bowel Disease.

Rautakorpi J, Kolehmainen S, Loyttyniemi E, Af Bjorkesten C, Arkkila P, Sipponen T Dig Dis Sci. 2025; .

PMID: 39946070 DOI: 10.1007/s10620-025-08876-5.

Comment on: [10 years of biologic use patterns in patients with inflammatory bowel disease: treatment persistence, switching and dose intensification - a nationwide population-based study].

Kamal S, Segal J Therap Adv Gastroenterol. 2024; 17:17562848241265761.

PMID: 39055324 PMC: 11271143. DOI: 10.1177/17562848241265761.

Effectiveness of adalimumab in severe ulcerative colitis: A systematic review and a meta-analysis.

Azadbakht S, Seighali M, Azadbakht S, Azadbakht M Health Sci Rep. 2024; 7(7):e2210.

PMID: 39035679 PMC: 11258201. DOI: 10.1002/hsr2.2210.

References

Szymanska S, Matuszczyk M, Osuch M, Meglicka M, Szymanska E, Bierla J . Inflammatory bowel disease - one entity with many molecular faces. Prz Gastroenterol. 2020; 14(4):228-232. PMC: 6983764. DOI: 10.5114/pg.2019.90249. View

Cote-Daigneault J, Bouin M, Lahaie R, Colombel J, Poitras P . Biologics in inflammatory bowel disease: what are the data?. United European Gastroenterol J. 2015; 3(5):419-28. PMC: 4625751. DOI: 10.1177/2050640615590302. View

Al-Bawardy B, Shivashankar R, Proctor D . Novel and Emerging Therapies for Inflammatory Bowel Disease. Front Pharmacol. 2021; 12:651415. PMC: 8080036. DOI: 10.3389/fphar.2021.651415. View

Raine T, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V . ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2021; 16(1):2-17. DOI: 10.1093/ecco-jcc/jjab178. View

Torres J, Bonovas S, Doherty G, Kucharzik T, Gisbert J, Raine T . ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis. 2019; 14(1):4-22. DOI: 10.1093/ecco-jcc/jjz180. View

Juillerat P, Grueber M, Ruetsch R, Santi G, Vuillemoz M, Michetti P . Positioning biologics in the treatment of IBD: A practical guide . Curr Res Pharmacol Drug Discov. 2022; 3:100104. PMC: 9092374. DOI: 10.1016/j.crphar.2022.100104. View

Rouse B, Chaimani A, Li T . Network meta-analysis: an introduction for clinicians. Intern Emerg Med. 2016; 12(1):103-111. PMC: 5247317. DOI: 10.1007/s11739-016-1583-7. View

Jansen J, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N . Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health. 2011; 14(4):417-28. DOI: 10.1016/j.jval.2011.04.002. View

Lasa J, Olivera P, Danese S, Peyrin-Biroulet L . Efficacy and safety of biologics and small molecule drugs for patients with moderate-to-severe ulcerative colitis: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2021; 7(2):161-170. DOI: 10.1016/S2468-1253(21)00377-0. View

10.

Peyrin-Biroulet L, Arkkila P, Armuzzi A, Danese S, Guardiola J, Jahnsen J . Comparative efficacy and safety of infliximab and vedolizumab therapy in patients with inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2022; 22(1):291. PMC: 9178865. DOI: 10.1186/s12876-022-02347-1. View

11.

Singh S, Murad M, Fumery M, Sedano R, Jairath V, Panaccione R . Comparative efficacy and safety of biologic therapies for moderate-to-severe Crohn's disease: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2021; 6(12):1002-1014. PMC: 8933137. DOI: 10.1016/S2468-1253(21)00312-5. View

12.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

13.

Higgins J, Altman D, Gotzsche P, Juni P, Moher D, Oxman A . The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. PMC: 3196245. DOI: 10.1136/bmj.d5928. View

14.

Mbuagbaw L, Rochwerg B, Jaeschke R, Heels-Andsell D, Alhazzani W, Thabane L . Approaches to interpreting and choosing the best treatments in network meta-analyses. Syst Rev. 2017; 6(1):79. PMC: 5389085. DOI: 10.1186/s13643-017-0473-z. View

15.

Salanti G, Ades A, Ioannidis J . Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2010; 64(2):163-71. DOI: 10.1016/j.jclinepi.2010.03.016. View

16.

Balduzzi S, Rucker G, Schwarzer G . How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 2019; 22(4):153-160. PMC: 10231495. DOI: 10.1136/ebmental-2019-300117. View

17.

van Valkenhoef G, Lu G, de Brock B, Hillege H, Ades A, Welton N . Automating network meta-analysis. Res Synth Methods. 2015; 3(4):285-99. DOI: 10.1002/jrsm.1054. View

18.

van Valkenhoef G, Dias S, Ades A, Welton N . Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis. Res Synth Methods. 2015; 7(1):80-93. PMC: 5057346. DOI: 10.1002/jrsm.1167. View

19.

Hanauer S, Feagan B, Lichtenstein G, Mayer L, Schreiber S, Colombel J . Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet. 2002; 359(9317):1541-9. DOI: 10.1016/S0140-6736(02)08512-4. View

20.

Colombel J, Sandborn W, Reinisch W, Mantzaris G, Kornbluth A, Rachmilewitz D . Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med. 2010; 362(15):1383-95. DOI: 10.1056/NEJMoa0904492. View