Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Crohn's Disease: 2025 AGA Evidence Synthesis.

Methods

We searched multiple electronic databases from inception through August 14, 2024, to identify randomized controlled trials in adults with moderate-to-severe CD, comparing advanced therapies (eg, tumor necrosis factor antagonists, vedolizumab, interleukin 12/23, or interleukin 23p19 antagonists, and/or Janus kinase inhibitors) with placebo or another active comparator.

我们从数据库创建之初至2024年8月14日，检索了多个电子数据库，以识别在中重度CD成人患者中进行的随机对照试验，比较了先进疗法（例如肿瘤坏死因子拮抗剂、vedolizumab、白细胞介素12/23或白细胞介素23p19拮抗剂，以及/或Janus激酶抑制剂）与安慰剂或另一种活性对照物。

Our primary outcomes were induction and maintenance of clinical remission; analyses were stratified by biologic therapy exposure status.

我们的主要结果是临床缓解的诱导和维持；分析按生物治疗暴露状态进行分层。

We performed a network meta-analysisusing a frequentist approach and applied the Grading of Recommendations, Assessment, Development and Evaluation to appraise certainty of evidence.

我们使用频率法进行了网络荟萃分析，并应用了推荐、评估、发展和评估的分级方法来评估证据的确定性。

Results

We identified 28 trials of induction therapy and 22 trials of maintenance therapy of advanced therapies in patients with moderate-to-severe CD.

我们确定了28项中度至重度克罗恩病患者的诱导治疗试验和22项维持治疗试验。

In biologic-naïve patients, moderate-to-high certainty evidence supported the use of infliximab, adalimumab, vedolizumab, ustekinumab, risankizumab, mirikizumab, and guselkumab, and low certainty evidence supported the use of certolizumab pegol and upadacitinib over no treatment for inducing remission.

在生物制剂未经治疗的患者中，中度至高度的证据支持使用英夫利昔单抗、阿达木单抗、维多珠单抗、乌司他木单抗、瑞舒伐单抗、米瑞克珠单抗和古塞尔库单抗，而低度证据支持使用赛妥珠单抗和乌帕替尼单抗相对于无治疗用于诱导缓解。

Among active comparators, moderate-to-high certainty evidence supported the use of adalimumab and ustekinumab compared with certolizumab pegol and upadacitinib.

在活性对照药物中，中到高程度的确凿证据支持使用阿达木单抗和乌司奴单抗，与certolizumab pegol和upadacitinib相比。

Among patients with prior exposure to biologics, moderate-to-high certainty evidence supported the use of adalimumab, ustekinumab, risankizumab, guselkumab, and upadacitinib, and low certainty evidence supported the use of vedolizumab and mirikizumab, over no treatment, for inducing remission.

在有生物制剂既往暴露史的患者中，中到高程度的确凿证据支持使用阿达木单抗、乌司奴单抗、瑞舒伐单抗、古塞尔库单抗和upadacitinib，与无治疗相比，用于诱导缓解；而低程度的确凿证据支持使用维多珠单抗和米瑞库珠单抗。

Among active comparators, moderate certainty evidence supported the use of risankizumab and guselkumab compared with vedolizumab and ustekinumab.

在活跃的对照药物中，中等质量的证据支持使用risankizumab和guselkumab，与vedolizumab和ustekinumab相比。

Conclusions

Using Grading of Recommendations, Assessment, Development and Evaluation to appraise quality of evidence, this updated network meta-analysiscan inform positioning of advanced therapies for the treatment of biologic-naïve and biologic-exposed patients with moderate-to-severe CD.

使用Grading of Recommendations, Assessment, Development and Evaluation评估证据质量，这项更新的网络荟萃分析可以为中度至重度CD的生物制剂初治和生物制剂暴露患者提供先进治疗的定位信息。