April 26, 2022
Does IBD duration affect the likelihood of achieving and maintaining remission with biologics?
Longer disease duration is associated with a reduced response to biologic therapy in Crohn’s disease but not in ulcerative colitis.
Ben-Horin S, Novack L, Mao R, et al. Efficacy of Biologic Drugs in Short-Duration Versus Long-Duration Inflammatory Bowel Disease: A Systematic Review and an Individual-Patient Data Meta-Analysis of Randomized Controlled Trials. Gastroenterol. 2022;162(2):482–94; https://doi.org/10.1053/j.gastro.2021
This systematic review and meta-analysis included 25 placebo-controlled trials of 6,168 Crohn’s disease (CD) patients and 3,227 ulcerative colitis (UC) patients who received infliximab, adalimumab, certolizumab, golimumab, natalizumab or vedolizumab. The authors compared rates of remission induction and maintenance among patients with short-duration (≤18 months) and long-duration (>18 months) disease.
Pooled findings for both placebo and treatment recipients with CD showed that 41.4% of those with short-duration disease achieved remission during induction periods, compared to 29.8% of those with longer-standing CD (Odds ratio [OR], 1.33 for short vs. long-duration CD; 95% Confidence Interval [CI], 1.09–1.64). For both short- and long-standing CD, the likelihood of achieving remission was higher with active treatment than placebo (OR for short duration, 1.47; 95% CI, 1.01–2.15 and OR for long duration, 1.43; 95% CI, 1.19–1.72). However, disease duration did not impact the likelihood of maintaining remission relative to placebo (Relative Rate [RR] for short duration, 1.15; 95% CI, 0.91–1.44 and RR for long duration, 1.15; 95% CI, 1.04–1.24).
In the UC analysis, 23.3% of all patients who received active treatment experienced remission induction, compared to 10.4% of placebo recipients. Disease duration did not impact the likelihood of remission induction (RR for short-duration, 1.82; 95% CI, 1.12–2.97 and RR for long-duration, 2.21; 95% CI, 1.79–2.72) nor of remission maintenance.
Study Design: Systematic review and meta-analysis
Funding: The Leona M. and Harry B. Helmsley Charitable Trust and the National Science Foundation of China.
Allocation: Not applicable
Level of Evidence: 1a