TOPLINE:

Advanced therapies yielded varying effects on health-related quality of life (HRQOL) in patients with moderate-to-severe ulcerative colitis (UC), with superior benefits seen with upadacitinib vs placebo or comparators.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis to evaluate the effect of advanced therapies on HRQOL in patients with moderate-to-severe UC.
• They included 28 randomised controlled trials reporting HRQOL outcomes, with 26 trials assessing outcomes during induction (involving 9686 participants) and 15 trials during maintenance (involving 1449 participants).
• Therapies assessed included intravenous infliximab, adalimumab, golimumab, intravenous vedolizumab, ustekinumab, mirikizumab, guselkumab, guselkumab plus golimumab combination therapy, risankizumab, etrasimod, upadacitinib, tofacitinib, and filgotinib.
• The primary outcome measure was the mean change in HRQOL as measured using the Inflammatory Bowel Disease Questionnaire (IBDQ) score during the induction and maintenance phases, with a minimal clinically important difference defined as at least 16 points.
• Secondary outcomes included mean changes in the Mental and Physical Component Summary scores of the Short Form-36 questionnaire (a minimal clinically important difference defined as at least 5 points) and the Work Productivity and Activity Impairment-UC score (a minimal clinically important difference defined as an improvement of at least 7.3%) as well as rates of IBDQ response and remission.

TAKEAWAY:

• During the induction phase, IBDQ scores were significantly increased with upadacitinib vs placebo (mean difference [MD], 32.91; 95% CI, 28.29-37.53), followed by filgotinib and guselkumab. Upadacitinib was also superior to all other therapies except the guselkumab-golimumab combination.
• In the maintenance phase, patients who received upadacitinib 30 mg (MD, 41.00; 95% CI, 10.89-71.11) and vedolizumab subcutaneously (MD, 39.77; 95% CI, 12.48-67.06) and intravenously (MD, 28.95; 95% CI, 8.32-49.58) vs placebo had significant improvements in HRQOL, although the clinical relevance was uncertain.
• Patients who received upadacitinib and ustekinumab had clinically meaningful reductions in the Work Productivity and Activity Impairment-UC scores in the induction phase, and those who received subcutaneous and intravenous vedolizumab had clinically meaningful reductions in the maintenance phase.
• Varying levels of improvement in the Short Form-36 questionnaire scores were observed with all therapies, with upadacitinib showing selective advantages. Upadacitinib vs comparators showed superior efficacy in achieving IBDQ response and remission.

IN PRACTICE:

"Incorporating patient-reported outcomes into treatment selection may enhance long-term satisfaction and functioning, reinforcing the importance of patient-centered, evidence-based therapeutic strategies in ulcerative colitis management,” the authors of the study wrote.

SOURCE:

This study was led by Anastasia Katsoula, MD, MSc, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece. It was published online on November 24, 2025, in the Journal of Crohn's and Colitis.

LIMITATIONS:

This study was limited by the inconsistent reporting of HRQOL across trials, design flaws in maintenance trials, and limited head-to-head comparisons that may have created significant challenges for accurately comparing the benefits of biologics vs small molecules.

DISCLOSURES:

This study was funded by a research grant from the Hellenic Group for the Study of IBD (EOMIFNE). The authors declared having no conflicts of interest.

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