Advanced therapies for inflammatory bowel disease associated with primary sclerosing cholangitis: a systematic review and meta-analysis

BACKGROUND AND AIMS: Up to 70%-80% of patients with primary sclerosing cholangitis (PSC) will have concomitant inflammatory bowel disease (IBD). Scarce data are available regarding outcomes of advanced therapies to treat IBD-PSC. We performed a systematic review and meta-analysis to assess the effectiveness and safety of advanced therapies in IBD-PSC. METHODS: A systematic search was conducted in Cochrane Library, Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science from database inception to January 29, 2025. We included studies that reported on IBD clinical response with advanced therapies. Meta-analysis was performed using the random effects model. Subgroup analyses were conducted to further investigate proportion differences between covariates. RESULTS: Nineteen studies (n = 864) were included in the final analysis. Among IBD-PSC patients treated with advanced therapies, clinical response was observed in 52% (95% CI, 40%-65%; I2 = 85%), clinical remission in 43% (95% CI, 25%-62%; I2 = 91%), and endoscopic remission in 26% (95% CI, 13%-42%; I2 = 75%). Infections occurred in 22% of patients (95% CI, 8%-40%; I2 = 82%) and acute cholangitis was observed in 14% of patients (95% CI, 2%-33%; I2 = 80%). The endoscopic remission rate with anti-tumor necrosis factor (anti-TNF) agents was 29% (95% CI, 10%-52%; I2 = 28%) vs. 15% (95% CI, 4%-29%; I2 = 70%) in those who received non-anti-TNF biologics. The rates of overall infections were similar in patients who received anti-TNF vs. non-anti-TNF biologics. CONCLUSIONS: Advanced therapies show efficacy and comparable safety in IBD-PSC. The study findings are limited by significant heterogeneity and further prospective studies with standardized endpoints are needed.