Risankizumab, Infliximab Show Best Efficacy for Inducing Remission of Crohn’s Disease

Infliximab 5 mg/kg took the top spot for inducing clinical remission in all patients with luminal Crohn’s disease, but risankizumab 600 mg was first in biologic-naïve and biologic-exposed patients, reported the authors of a recent meta-analysis.

“There are numerous biological therapies and small molecules licensed for luminal Crohn disease, but these are often studied in placebo-controlled trials, meaning relative efficacy is uncertain. We examined this in a network meta-analysis,” wrote corresponding author Alexander C. Ford, MD, a professor of gastroenterology at the University of Leeds in the United Kingdom, and coauthors, in Gut.

Researchers gauged treatment efficacy by induction of clinical remission and maintenance of clinical remission overall, as well as in patients with previous and no exposure to biologics. The analysis included 25 induction of clinical remission trials with a total 8720 patients and 15 maintenance of remission trials with 4016 patients.

For remission induction efficacy, infliximab 5 mg/kg ranked first compared with placebo (researchers reported a 0.67 pooled relative risk), risankizumab 600 mg ranked second, and upadacitinib 45 mg once daily ranked third, according to the study. When researchers looked at remission induction with and without previous biologic exposure, however, they found risankizumab 600 mg ranked first in biologic-naïve (0.66 pooled relative risk) and in biologic-exposed patients (0.74 pooled relative risk).

For remission maintenance, upadacitinib 30 mg once daily ranked first (0.61 pooled relative risk), adalimumab 40 mg weekly ranked second, and infliximab 10 mg/kg every 8 weeks ranked third. In biologic-naïve patients, adalimumab 40 mg weekly ranked first (0.59 pooled relative risk), researchers reported. And in patients with previous biologic exposure, vedolizumab 108 mg every 2 weeks ranked first (0.70 pooled relative risk).

Reference:
Barberio B, Gracie DJ, Black CJ, Ford AC. Efficacy of biological therapies and small molecules in induction and maintenance of remission in luminal Crohn’s disease: systematic review and network meta-analysis. Gut. 2023;72(2):264-274. doi:10.1136/gutjnl-2022-328052