SynthesisPloS one2025
Second-line treatment strategies of ulcerative colitis after conventional therapy failure: A systematic review and network meta-analysis of randomized controlled trials.
Synthesis in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
7 authors.
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Abstract
purposeThis study aimed to compare the efficacy and safety of pharmacotherapies for ulcerative colitis (UC), promoting more precise management of refractory ulcerative colitis.
methodsRelevant randomized controlled trials involving refractory UC patients were systematically searched in electronic databases, including MEDLINE, EMBASE, and the Cochrane Library. Data were independently extracted by three investigators. Risk ratios (RRs) with 95% confidence intervals (CI) were calculated for key outcomes: remission, response, mucosal healing, and serious adverse events using random-effects models. Network meta-analysis, utilizing a frequency model, established comparative rankings, with surface under cumulative ranking curve (SUCRA) determining optimal treatments.
resultsA total of nineteen studies, containing 5,450 patients, were included. In the induction phase, Qing-Chang-Hua-Shi emerged as the most effective drug for remission (RR vs placebo 0.78, 95% CI 0.64-0.95; SUCRA, 0.89). Cyclosporine showed the most promising effect for treatment response (RR 0.22, 95% CI 0.07-0.67; SUCRA, 0.90). Tacrolimus was most effective in terms of mucosal healing (RR 0.57, 95% CI 0.44-0.73; SUCRA, 0.89). Recombinant interferon-β-1a exhibited the lowest risk of serious adverse events (RR 0.08, 95% CI 0.01-0.62; SUCRA, 0.94).
conclusionNo single drug demonstrated consistent superiority across all four evaluated outcomes for refractory ulcerative colitis. Treatment strategies should therefore be individualized according to specific clinical objectives and the quality of available evidence.
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