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Pharmacologic therapies for severe steroid refractory hospitalized ulcerative colitis: A network meta‐analysis
Author(s) -
Komaki Yuga,
Komaki Fukiko,
Micic Dejan,
Yamada Akihiro,
Suzuki Yasuo,
Sakuraba Atsushi
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13674
Subject(s) - medicine , infliximab , ulcerative colitis , adverse effect , tacrolimus , colectomy , discontinuation , randomized controlled trial , placebo , meta analysis , transplantation , disease , alternative medicine , pathology
Background and Aim A limited option of therapies is available for hospitalized patients with severe steroid refractory ulcerative colitis (UC). Furthermore, there exists a paucity of direct comparisons between them. To provide a comparative evaluation of the efficacy and safety of pharmacologic therapies, we conducted a network meta‐analysis combined with a benefit–risk analysis of randomized controlled trials (RCTs) performed in hospitalized patients with severe steroid refractory UC. Methods Electronic databases were searched through November 2015 for RCTs evaluating the efficacy of therapies for severe steroid refractory hospitalized UC. The outcomes were clinical response, colectomy free rate, and severe adverse events leading to discontinuation of therapy. The primary endpoints were the rank of therapies based on network meta‐analysis combined with benefit–risk analysis between clinical response and severe adverse events as well as colectomy free rate and severe adverse events. Results Eight RCTs of 421 patients were identified. Cyclosporine, infliximab, and tacrolimus as well as placebo were included in our analysis. Network meta‐analysis with benefit–risk analysis simultaneously assessing clinical response and severe adverse events demonstrated the rank order of efficacy as infliximab, cyclosporine, tacrolimus, and placebo. Similar analysis for colectomy‐free rate and severe adverse events demonstrated the same rank order of efficacy. The differences among infliximab, cyclosporine, and tacrolimus were small in all analyses. Conclusion The results of the present comprehensive benefit–risk assessment using network meta‐analysis provide RCT‐based evidence on efficacy and safety of infliximab, cyclosporine, and tacrolimus for hospitalized patients with severe steroid refractory UC.