Efficacy of Advanced Therapies in Achieving Remission by Disease Location in Crohn's Disease: A Systematic Review and Meta-analysis.
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BACKGROUND AND AIMS: We compared the efficacy of different advanced therapies by disease location in patients with Crohn's disease (CD) through a systematic review and meta-analysis. METHODS: Through a systematic review, we identified 14 RCTs in 3,139 patients with moderate-to-severe CD who were treated with different advanced therapies vs. placebo, and reported efficacy in inducing clinical remission, stratified by disease location (isolated colonic versus ileal disease, excluding ileocolonic disease). We grouped advanced therapies based on primary mechanism of action: anti-interleukins, Janus kinase inhibitors (JAK inhibitors), anti-integrins and tumor necrosis factor (TNF) antagonists. We calculated treatment efficacy (drug vs. placebo), overall and by drug class, for colonic vs. ileal disease. RESULTS: Overall treatment efficacy of advanced therapies vs. placebo was higher in patients with colonic (OR, 4.09 [95% CI, 3.02-5.54]) vs. ileal CD (OR, 1.80 [1.23-2.63]) (p<0.001). By drug class, anti-interleukins demonstrated a higher efficacy in colonic disease (OR, 4.29 [2.77-6.64]) vs. ileal disease (OR, 2.31 [1.44-3.70]) (p=0.059), whereas no difference in efficacy was observed with anti-integrins (colonic vs. ileal: OR, 1.79 [0.55-5.87] vs. 2.10 [0.80-5.53], p=0.84). For JAK inhibitors, efficacy was observed only in patients with isolated colonic disease (OR, 4.37 [2.67-7.15]), but not in ileal disease (OR, 1.01 [0.54-1.89]) (p<0.001). All analyses had minimal to moderate heterogeneity. CONCLUSION: The magnitude of efficacy of advanced therapies for ileal CD is generally lower compared with isolated colonic CD, with JAK inhibitors showing particularly limited efficacy for ileal disease. These results may help inform treatment selection.
