Presentation (CTI)

OBJECTIVES: To assess the agreement between clinical remission and response outcomes and determine whether endpoint choice influences comparative efficacy conclusions in network meta-analyses of first-line biologic therapies for moderate-to-severe Crohn’s disease, given inconsistent endpoint reporting across trials.
METHODS: An AI-assisted systematic literature review (SLR) was conducted using ActiveSLR^Plus in PubMed and Embase from database inception to May 2026. Eligible studies included adults with moderate-to-severe CD with inadequate response, loss of response, or intolerance to conventional therapies. Separate Bayesian network meta-analyses (NMAs) were conducted for induction-phase clinical response and clinical remission. Treatments common to both networks were compared using ‘surface under the cumulative ranking curve’ (SUCRA) rankings, and concordance was quantified using Spearman’s rank correlation coefficient.
RESULTS: Nineteen RCTs (42 publications) were included. Ten treatments were common to both efficacy networks and included in the comparative analysis. Treatment rankings derived from clinical response and remission were strongly correlated (Spearman’s ρ = 0.82). Overall efficacy patterns were consistent across endpoints, with stability observed among top and lower ranked treatments. Modest differences were observed among mid-ranked therapies. Treatments demonstrating favorable efficacy according to one endpoint generally showed similar performance according to the other, indicating substantial agreement between clinical response and clinical remission outcomes.
CONCLUSIONS: Clinical response and remission yield highly consistent comparative efficacy patterns in NMAs of Crohn’s disease therapies. These findings suggest that endpoint selection is unlikely to change overall NMA conclusions while warranting caution for closely ranked therapies.