The researchers suggest more research, including head-to-head trials, to sort out the relative merits of the treatments for ulcerative colitis.
Biologics have become the standard of care for induction of remission and maintenance therapy in the treatment of moderate to severe ulcerative colitis. Currently approved agents include several Janus kinase (JAK) inhibitors and tumor necrosis factor-alpha (TNF-alpha) blockers, the integrin receptor antagonist Entyvio (vedolizumab) and the interleukin-12 and -23 inhibitor Stelara (ustekinumab). The sphingosine 1-phosphate receptor modulator Zeposia (ozanimod) is an exception to the rule and is a small molecule.)
For people whose disease has advanced to more severe stages, achieving early remission could mean a reduction in corticosteroid use and, in some cases, may reduce the risk of colectomy (colon removal surgery).
In a systematic review published in The American Journal of Gastroenterology last month, Dhruv Ahuja, M.B.B.S., from the Department of Medicine at Indira Gandhi Hospital in New Delhi, India, and colleagues, analyzed and compared the time to symptomatic remission in several therapies FDA-approved to treat moderate to severe ulcerative colitis. The therapies in their view included Entyvio, Stelara, Zeposia, the JAK inhibitors Rinvoq (upadacitinib), Xeljanz (tofacitinib), and Jyseleca (filgotinib), and the TNF-alpha antagonists Remicade (infliximab), Humira (adalimumab), and Simponi (golimumab).
The researchers conducted a systematic literature review through December 31, 2022, identifying randomized trials of adult outpatients with moderate to severe ulcerative colitis treated with the FDA-approved therapies mentioned above. The included studies reported rates of symptomatic remission based on partial Mayo score, with resolution of rectal bleeding and near-normalization of stool frequency at weeks 2, 4, and 6.
The study results showed that Rinvoq was more effective than the other therapies in achieving symptomatic remission at weeks 2, 4, and 6. Additionally, the three TNF-alpha antagonists and the JAK inhibitor Jyseleca were more effective than the oral drug Zeposia in achieving symptomatic remission at week 2. Stelara and Entyvio also effectively achieved early remission, although only in biologic-naïve patients.
Upon comparison, Rinvoq was the most likely to achieve early symptomatic remission, followed by Humira, Remicade, Simponi, and Jyseleca.
The study authors recommend further research, including head-to-head trials comparing these treatments, to help solidify the position of these therapies in achieving rapid symptomatic remission.