Evidence map›Paper›PMID 39425738›Full record

SynthesisGastroenterology2024

Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis.

Ashwin N Ananthakrishnan, M Hassan Murad, Frank I Scott, Manasi Agrawal, John P Haydek, Berkeley N Limketkai, Edward V Loftus, Siddharth Singh

Abstract readSystematic ReviewComparative StudyNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Gastroenterology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Article
  10. Article
  11. UBE2L6 drives ulcerative colitis progression by promoting BIRC2 degradation and activating non-canonical NF-κB signalling.Inflammation research : official journal of the European Histamine Research Society ... [et al.] · 2026
    Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. STRIDE-II treatment target achievement in inflammatory bowel disease: a cross-sectional study from a tertiary IBD centre in the United Arab Emirates.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2026
    Article
  17. Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ashwin N AnanthakrishnanDivision of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
M Hassan MuradRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
Frank I ScottCrohn's and Colitis Center, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Denver, Colorado.
Manasi AgrawalThe Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
John P HaydekDivision of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Berkeley N LimketkaiVatche & Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, School of Medicine, Los Angeles, California.
Edward V LoftusDivision of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Siddharth SinghDivision of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, California. Electronic address: sis040@ucsd.edu.

Funding

Determinants of inception of inflammation in inflammatory bowel diseasesR01DK127171 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI ANANTHAKRISHNAN, ASHWIN N, XAVIER, RAMNIK J · 2021 to 2025
$5.4M
Comparative effectiveness research in Hispanic patients with inflammatory bowel diseasesR01DK135937 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Siddharth Singh · 2024 to 2026
$1.9M
Early-life Risk Factors for Inflammatory Bowel DiseaseK23DK129762 · NIDDK · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI AGRAWAL, MANASI · 2021 to 2025
$951k
NCCDPHP CDC HHS U01 DP006745NIDDK NIH HHS K23 DK129762NIDDK NIH HHS R01 DK127171NIDDK NIH HHS R01 DK135937
6 · The paper itself

Abstract

BACKGROUND &

aimsWe performed an updated systematic review and network meta-analysis to inform the 2024 American Gastroenterological Association (AGA) Clinical Guidelines on the management of moderate-to-severe ulcerative colitis (UC).

methodsWe searched multiple electronic databases through November 21, 2023, to identify randomized controlled trials in adults with moderate-to-severe UC, comparing different advanced therapies (tumor necrosis factor antagonists, vedolizumab, sphingosine-1-phosphate receptor modulators, interleukin 12/23 or selective interleukin 23 antagonists, and Janus kinase [JAK] inhibitors) against placebo or another active comparator. Our primary outcomes were induction and maintenance of clinical remission, and our secondary outcome was endoscopic improvement. We performed a network meta-analysis using a frequentist approach and applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to appraise certainty of evidence.

resultsAfter excluding JAK inhibitors as potential first-line treatment (in accordance with the United States Food and Drug Administration), low-certainty evidence supports clinically important benefit with infliximab, ozanimod, risankizumab, and guselkumab over adalimumab and mirikizumab for achieving remission with induction therapy in biologically naïve patients with moderate-to-severe UC, with risankizumab and ozanimod being ranked the highest for induction of clinical remission. With the inclusion of JAK inhibitors as first-line therapy, upadacitinib was more efficacious compared with all other medications except ozanimod and risankizumab, with low- to moderate-certainty evidence. In patients with prior biologic exposure, upadacitinib, tofacitinib, and ustekinumab were ranked highest for achieving remission.

conclusionsUsing Grading of Recommendations, Assessment, Development and Evaluation to appraise quality of evidence, this updated network meta-analysis will be used to inform comparative efficacy and positioning of advanced therapies for the treatment of biologic-naïve and biologic-exposed patients with moderate-to-severe UC.

Indexed as

Colitis, UlcerativeRemission InductionSeverity of Illness IndexAntibodies, Monoclonal, HumanizedComparative Effectiveness ResearchGastroenterologyGastrointestinal AgentsHumansJanus Kinase InhibitorsPiperidinesRandomized Controlled Trials as TopicSocieties, MedicalSphingosine 1 Phosphate Receptor ModulatorsTreatment OutcomeTumor Necrosis Factor InhibitorsUnited StatesAntibodies, Monoclonal, HumanizedGastrointestinal AgentsJanus Kinase InhibitorsPiperidinesSphingosine 1 Phosphate Receptor ModulatorsTumor Necrosis Factor InhibitorsvedolizumabBiologicsComparative EffectivenessGuidelinesInflammatory Bowel DiseasesPositioning

Identifiers

PMID39425738
PMCPMC12148344

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.