Meta-analysis Of Indirect Comparison Of The Efficacy And Safety Of Ustekinumab And Vedolizumab In The Treatment Of Inflammatory Bowel Disease

Objective:By indirect comparison,we compared the efficacy and safety of two novel biological agents,ustekinumab(UST)and vedolizumab(VDZ),for the treatment of inflammatory bowel disease(IBD),which mainly includes ulcerative colitis(UC)and Crohn’s disease(CD),in order to guide the formulation of treatment strategies in clinical work.Methods:Randomized controlled trials(RCTs)included in Pub Med,Embase,Web of Science,Cochrane Library,CNKI,CBMand Wanfang Databases were retrieved by computer from the database until December 2020.Through strict inclusion and exclusion criteria,data were screened and extracted.Revman5.4 and ITC software were used for meta-analysis and indirect comparison of the included studies.Results:A total of nine RCTs were included in the study,including three studies on ustekinumab against inflammatory bowel disease(1 UC,2 CDs),and six studies on vedolizumab against inflammatory bowel disease(3 UC,3 CDs),covering 7957 patients,including 5647 in the experimental group and 2310 in the placebo group.The meta-analysis results of direct comparison showed that(1)Efficacy: The clinical response rate and clinical response rate included.The clinical response rates of UST and VDZ were both superior to those of the control placebo group.The Relative risk(RR)and 95%confidence interval(95%CI)were respectively: [RR=1.82,95%CI(1.59,2.10),P<0.001 and [RR=2.14,95%CI(1.80,2.54),P<0.001];The clinical response rates of USTand VDZ are both superior to that of the control placebo group;the relative risk degree and95% confidence interval are respectively [RR = 1.66,95%CI(1.52,1.81),P<0.001]、[RR=1.51,95%CI(1.25,1.82),P<0.001];(2)Safety: adverse reaction rate: compared with placebo,there was no significant difference in relative risk and 95% confidence interval of USTand VDZ [RR = 0.96,95%CI(0.91,1.01),P=0.08]、[RR=0.98,95%CI(0.93,1.04),P=0.53];The results of the indirect comparison meta-analysis showed that(1)In terms of efficacy,the clinical remission Meta of UST vs VDZ [RR=1.18,95%CI(0.94,1.48),and P=0.59];Clinical response rate of UST vs VDZ [RR=0.91,95%CI(0.74,1.12),P = 0.94];(2)Safety: The adverse reaction rate of UST vs VDZ[RR=1.02,95%CI(0.95,1.10),P=0.93].Conclusion:No significant difference in clinical remission rate,clinical reaction rate and adverse reaction rate between the two biological preparations of ustekinumab and vedolizumab,in the induction and maintenance treatment for patients with inflammatory bowel disease.