Summary

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• This summary is based on the review of 113 systematic review(s)/meta-analysis(es). ^[1-113]
• Induction of Clinical Remission: Infliximab (IFX) was highly effective for inducing remission in both Crohn’s disease (CD) and ulcerative colitis (UC), particularly among biologic-naive patients, outperforming both vedolizumab (VDZ) and adalimumab in certain comparisons. Upadacitinib and tofacitinib also showed high efficacy in UC, with upadacitinib ranking highest for induction in moderate-to-severe cases.
• Maintenance of Clinical Remission: During maintenance, infliximab combined with azathioprine demonstrated superior efficacy in sustaining remission across CD and UC. Vedolizumab was ranked highest for maintaining remission in UC, and ustekinumab showed effective maintenance in both CD and UC populations.
• Endoscopic Improvement: Infliximab achieved significant endoscopic improvement during maintenance therapy, particularly in UC, while vedolizumab ranked highly for this outcome in UC. Both ustekinumab and tofacitinib were effective for endoscopic improvement in UC patients.
• Comparative Efficacy Among Biologics: Infliximab showed superior induction efficacy over vedolizumab but comparable maintenance effectiveness. Tofacitinib and upadacitinib provided robust efficacy in UC, with upadacitinib showing the highest induction effect. Adalimumab was effective but generally showed lower efficacy in comparison to IFX and VDZ, especially in biologic-experienced patients.
• Adverse Events (AEs): Infliximab and vedolizumab demonstrated similar rates of overall adverse events, while tofacitinib was associated with higher rates of adverse events, particularly infections, compared to placebo. Ustekinumab had a favorable safety profile similar to placebo, and adalimumab showed a comparable safety profile to other tumor necrosis factor (TNF) inhibitors.
• Serious Adverse Events (SAEs): Infliximab and ustekinumab showed similar rates of serious adverse events to placebo. Vedolizumab presented a lower risk of serious infections compared to other biologics, whereas tofacitinib was linked to an increased risk of serious infections, particularly at higher doses.
• Infections: Infliximab and adalimumab had higher risks of infections relative to placebo, with comparable infection rates between the two. Vedolizumab demonstrated a lower infection risk compared to TNF inhibitors, while tofacitinib had a notably higher risk of both general and serious infections.
• Comparative Safety: Vedolizumab had a lower risk of serious infections compared to infliximab, and ustekinumab generally showed a more favorable safety profile with fewer serious adverse events in comparison to TNF inhibitors.
• Age and Disease Duration: Older patients presented a higher baseline risk of serious adverse events, yet there was no additional risk associated with anti-TNF therapy compared to younger patients. Conversely, biologic-naive patients and those with shorter disease duration exhibited better clinical outcomes and response rates, indicating a need for tailored treatment strategies based on age and disease characteristics.
• Gender and Smoking Status: Men experienced lower rates of clinical remission and response compared to women during induction therapy with TNF inhibitors. Additionally, current smokers demonstrated reduced efficacy with TNF inhibitors, which may significantly influence treatment outcomes.