Systematic Literature Review and Meta-Analysis of Endoscopic Improvement for Treatment of Moderate-Severe Ulcerative Colitis

OBJECTIVES: Endoscopic improvement (Mayo Endoscopic Subscore 0 or 1) and endoscopic remission (Mayo Endoscopic Subscore 0) are recognized as important treatment endpoints in ulcerative colitis (UC). Endoscopic improvement is associated with reduced risk of relapse, hospitalization, dysplasia, cancer, and need for colectomy. The objective of this analysis was to assess the overall effect of UC treatments for Endoscopic improvement.

METHODS: PubMed and Embase databases were searched for English language papers and conference abstracts published through March 18, 2022. Studies were selected for inclusion if patients were treated with biologics or small molecules for moderate-severe Ulcerative Colitis (UC). Random-effects meta-analyses were conducted to compare Endoscopic Improvement for all treatments versus placebo, biologics versus placebo and small-molecules versus placebo. Endoscopic improvement was defined as Mayo endoscopic sub-score 0–1.

RESULTS: A total of 2593 records were identified, of which 22 references met the selection criteria for systematic review. A total of 8841 patients were studied, with 5555 in the intervention arm and 3286 the placebo arm. Meta-analysis found that all included treatments led to endoscopic improvements versus placebo, with an Odd Ratio (OR) 2.360 (95% CI-1.923, 2.897, p<0.05). For small molecules, the OR was 3.495 (95% CI-2.214, 5.515, p<0.05). For biologics, the OR was 1.940 (95% CI-1.657, 2.271, p<0.05).

CONCLUSIONS: Studies show that treatments lead to endoscopic improvement compared to placebo. Small molecules had a higher odds ratio than biologics for endoscopic improvement.