Comparative Effectiveness of Advanced Therapies in Inflammatory Bowel Disease

Abstract Purpose of review Numerous biologic and small molecule therapies have been approved in recent decades for use in the treatment of Crohn’s disease and ulcerative colitis. This review will summarize recent data on comparativeness effectiveness of advanced therapies in inflammatory bowel disease. Recent findings Multiple head-to-head, randomized comparisons of biologic therapies have had data published in recent years (Table 1). Ustekinumab and adalimumab for the treatment of moderate to severe Crohn’s disease were compared in the SEAVUE study, with findings of similar rates of clinical remission at week 52, endoscopic improvement, and endoscopic remission between the two agents. In the VARSITY study, vedolizumab demonstrated superior rates of achieving clinical remission and endoscopic improvement at week 52 when compared to adalimumab for the treatment of moderate to severe ulcerative colitis. Several network meta-analyses have been completed to compare individual biologic and small molecule therapies. Vedolizumab demonstrates less favorable efficacy in previously anti-TNF exposed patients, supportive of previously published data. Key findings from the SEQUENCE study found that, compared to ustekinumab, risankizumab demonstrated non-inferiority in achieving clinical remission at week 24 and superior in attaining endoscopic remission at week 48. GALAXI 2-3 and VIVID-1 demonstrated no clear superiority of guselkumab or mirikizumab to ustekinumab in patients in both clinical and endoscopic outcomes assessed in these studies. Summary There is a relatively limited body of randomized, head-to-head trials comparing biologic agents and/or small molecules for the treatment of inflammatory bowel disease, with available data largely limited to network meta-analyses. Additional prospective, head-to-head trials are needed to address these knowledge gaps and allow for more evidence-based positioning of therapies.