UC, CD duration does not affect treatment response to biologics

Disease duration of ulcerative colitis (UC) or Crohn’s disease (CD) does not seem to affect the proportional biologic-to-placebo treatment effect on remission, a new meta-analysis has found.

Researchers conducted an online search of Medline, Embase, the Cochrane CENTRAL Register of Controlled Trials, the Cochrane IBD Group Specialized Trials Register, and Clinicaltrials.gov. They retrieved 25 eligible trials, 16 of which investigated CD (n=6,186) and nine looked at UC (n=3,227).

The primary outcome was the proportion of induced remission by biologic drugs vs placebo, compared between patients with short (≤18 months) vs long (>18 months) disease duration. Individual-patient-data meta-analysis of 11 CD studies (n=3,592) showed that 37.8 percent and 26.5 percent of patients in the active vs placebo arm achieved remission.

Further stratifying by disease revealed that the proportional biologic-to-placebo remission was comparable in patients with short-duration (risk ratio [RR], 1.47, 95 percent confidence interval [CI], 1.01–2.15) and long-duration (RR, 1.43, 95 percent CI, 1.19–1.72) CD. Logistic regression confirmed the null interaction between treatment effect and disease duration (p=0.585).

In nine UC trials (n=2,763), remission was observed in 23.3 percent and 10.4 percent of the active and placebo arms, respectively. As in the case of CD, the proportional treatment effect on remission was comparable between patients with short-duration (RR, 1.82, 95 percent CI, 1.12–2.97) vs long-duration (RR, 2.21, 95 percent CI, 1.79–2.72) disease.

“These findings provide novel insights on temporal aspects of efficacy of biologics positioned against the duration of inflammatory bowel disease at initiation of treatment,” the researchers said.