TOPLINE

Adalimumab was associated with moderate certainty of evidence for maintaining clinical remission in patients with Crohn's disease (CD). Upadacitinib was linked to high certainty of evidence for preventing loss of clinical response.

METHODOLOGY

• Researchers conducted a systematic review and network meta-analysis including 37 randomized controlled trials involving 7415 participants, to compare maintenance therapies for patients with CD.
• Participants were in remission or response to previous treatment. Trial durations ranged from 22 to 108 weeks.
• Researchers searched databases through June 2025 and evaluated up to 20 interventions across biologics, biosimilars, JAK inhibitors, small molecules, and immunomodulators.
• The primary outcome was clinical relapse. Secondary outcomes included loss of clinical response, endoscopic relapse, total and serious adverse events (AEs), and withdrawals due to AEs.
• Heterogeneity (I2) and certainty of evidence were assessed.

TAKEAWAY

• Adalimumab was associated with a reduced risk for clinical relapse compared with placebo (33 studies; risk ratio [RR], 0.68; 95% CI, 0.54-0.84), with moderate certainty of evidence. The network I2 was 55.7%.
• Upadacitinib was associated with a reduced risk for loss of clinical response than placebo (17 studies; RR, 0.64; 95% CI, 0.57-0.72), with high certainty. The network I2 was 0%.
• CT-P13, natalizumab, certolizumab, adalimumab, and ustekinumab were associated with reduced risk for loss of clinical response, with moderate certainty.
• Safety analyses did not show a clear increase in withdrawals (28 studies), serious adverse events (SAEs) (23 studies), or total AEs (23 studies).

IN PRACTICE

"Novel therapies seem to have similar effect sizes of efficacy while maintaining good safety records, though imprecision because of limited evidence precludes further conclusions," the authors of the study wrote.

SOURCE

The study was led by Vassiliki Sinopoulou, University of Lancashire, Preston, England, and Morris Gordon, University of Lancashire, Preston, England. It was published online on July 27 in Therapeutic Advances in Gastroenterology.

LIMITATIONS

All intervention doses were combined, preventing analyses on specific dosing regimens. Baseline disease activity and follow-up duration varied across trials. No included trials enrolled biologic-naive patients.

DISCLOSURES

The authors reported no funding for this research. Several authors disclosed receiving consulting fees, research grants, or speaker honoraria from pharmaceutical companies including AstraZeneca, Bristol Myers Squibb, and Janssen. Detailed author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.