Posted 5/25/2022 10:09 AM (GMT 0)
Thank you this is very interesting!
A word of caution that this is a meta-analysis of existing studies which has multiple flaws (data biases and inconsistencies between studies). The best (ideal) comparison would be a head-to-head trial of different drugs, of which there are very few studies to date (so far I'm only aware of entyvio vs humira which showed entyvio was more effective).
The drug that really shines here is upadacitinib (rinvoq). Where xeljanz and stelara appear to outperform is in the patients who have previously been exposed to biologics and who by definition will have already lost response/been unresponsive to anti-TNF or anti-integrin (entyvio) treatments. Since there seem to be different subsets of UC patients (those who respond to TNF- and those who respond to JAK-inhibitors) I would not take the results in bio-exposed patients as indicating that xeljanz is superior to anti-TNFs or anti-integrin, because you're comparing different types of patients.
If you look at the results for biologic-naive patients then the only drug which clearly performs better than others is rinvoq (especially when you look at endoscopic improvement - and TNF inhibitors are omitted from some of the later plots for unknown reasons).
Other things that stood out for me is that humira is the least effective, and adverse events on JAK inhibitors are not higher than on anti-TNF treatments (since xeljanz get a bad rap on here for being more risky than other treatments).
Thanks again for sharing this.