Su1867 – Sustainanility of Biologic Therapies is Less in Ulcerative Colitis that Crohns Disease Patients Independent of Prior Biologic Experience

Background: Direct head-to-head comparisons of the efficacy and safety of advanced therapies for ulcerative colitis are limited.We performed a systematic literature review and indirect treatment comparison of randomized controlled trials of biologics and tofacitinib for ulcerative colitis.Methods: Medline, Embase, and Cochrane Library databases were searched from 1997 to July 2018 to identify randomized controlled trials of vedolizumab, adalimumab, infliximab, golimumab, and tofacitinib.Efficacy outcomes were sustained response and remission at 1 year.Safety outcomes were overall adverse events, serious adverse events, overall infections, serious infections, and adverse events leading to discontinuation as reported at 1 year.Odds ratios with 95% credible intervals were estimated using network metaanalyses and were transformed into number-needed-to-treat (NNT) and number-neededto-harm (NNH) using the pooled placebo estimates across all trials.Results: are reported for the overall population and among biologic-naïve patients.Data for sustained response and remission with tofacitinib for biologic-naïve patients were not available.Results: Six randomized controlled trials were included in the network meta-analyses.Overall, vedolizumab 300 mg every 8 weeks had statistically significantly higher chances of sustained response and remission (odds ratio: 2.20 [1.07-4.64]and 2.57 [1.09-6.13],respectively) compared with adalimumab.In biologic-naïve patients, vedolizumab 300 mg every 8 weeks had numerically higher odds of both sustained response and remission compared with all other therapies; however, the results were not statistically significant (data not shown).Compared with placebo, the odds ratio of sustained remission was statistically significantly higher for all the interventions (Table 1).The lowest NNT for sustained remission was with tofacitinib in the overall population and with vedolizumab in biologic-naïve patients.Similar trends were observed for sustained response.The risk of all the adverse events (including serious adverse events) was numerically the lowest with vedolizumab, with NNH values closest to placebo (Table 2).Conclusions: Indirect treatment comparisons from this network metaanalyses suggested vedolizumab may achieve higher rates of both sustained response and sustained remission than comparator therapies in the overall study populations and was associated with lowest risk of adverse events.These findings support the favorable benefitrisk profile of vedolizumab in ulcerative colitis, especially in biologic-naïve patients.Headto-head trials are required to confirm the findings.