OBJECTIVES: The aim of this study was to assess the efficacy of vedolizumab, adalimumab, golimumab, infliximab, and tofacitinib for moderate-to-severe ulcerative colitis in anti-TNF-alpha-naïve, adult patients in randomized clinical trials.

METHODS: We previously performed a comprehensive search of PubMed to identify randomized clinical trials with results published up to November 2019 that assess the efficacy of at least one of infliximab, adalimumab, golimumab, vedolizumab, and tofacitinib comparing them to placebo or other treatments in the induction phase and/or maintenance phase of therapy for moderate to severe ulcerative colitis. In this study, we performed fixed effect network meta-analysis to synthesize the odds ratios.

RESULTS: In the induction phase, fourteen studies showed that all treatments were significantly better than placebo in clinical response, and infliximab was ranked top in the network (OR: 3.54, 95% CI: 2.72-4.62, P-score for the ranking: 0.858). For clinical remission in the maintenance phase, eleven studies assessed treatments other than tofacitinib and showed that they were significantly better than placebo, and vedolizumab was ranked top in the network (3.73, 2.37-5.87, 0.949). Six studies assessed treatments other than tofacitinib for sustained clinical response and showed that they were significantly better than placebo, and infliximab was ranked top in the network (4.30, 2.89-6.40, 0.895).

CONCLUSIONS: Infliximab, adalimumab, golimumab, vedolizumab, and tofacitinib were efficacious in clinical response in the induction phase, and the four treatments other than tofacitinib had data to support their efficacy in clinical remission in the maintenance phase and sustained clinical response. Fixed effect network meta-analysis showed that infliximab was ranked top in the networks for five of the six outcomes reviewed in this study but that vedolizumab was ranked top in the network for clinical remission in the maintenance phase.