Ahmed Hassan, MBBCh1, Amr Mostafa, MBBCh2, Sara Elsenary, MBBCh3, Ahmed Elsayed, MBBCh3, Mariam Mohamed, MBBCh4, Karim Ahmed, MBBCh5, Nehal Kasem, MBBCh3, Nancy Bekhit, MBBCh6, Zeina Sayed, MBBCh7, Mahmoud M. Elsayed, MD8 1Columbia University Irving Medical Center, New York, NY; 2MME Foundation, Zayed, Al Jizah, Egypt; 3New Giza University, New Cairo, Al Qahirah, Egypt; 4New Giza University, Rehab City, Al Qahirah, Egypt; 5Newgiza University, Zayed, Al Jizah, Egypt; 6New Giza University, Maadi, Al Qahirah, Egypt; 7New Giza University, Obour, Al Qalyubiyah, Egypt; 8MME Foundation, Monsoura, Ad Daqahliyah, Egypt Introduction: Biologic therapies have revolutionized the management of ulcerative colitis (UC), yet real-world and trial-based evidence on their long-term comparative effectiveness and safety remains limited. Understanding sustained clinical remission, mucosal healing, and long-term tolerability is essential to optimizing treatment algorithms.
To compare the long-term efficacy and safety of approved biologics and small molecules for moderate-to-severe UC using a network meta-analysis of maintenance-phase randomized controlled trials (RCTs).
Methods: A systematic review and network meta-analysis were performed per PRISMA-NMA standards. MEDLINE, EMBASE, and CENTRAL databases were searched through April 2024. Phase 3 RCTs evaluating maintenance therapy (≥12 months) with infliximab, adalimumab, vedolizumab, ustekinumab, tofacitinib, or upadacitinib were included. Primary outcome: maintenance of clinical remission. Secondary outcomes: endoscopic and histologic remission, and serious adverse events (SAEs). Analysis was conducted in R using netmeta and gemtc packages. Results: Twenty-one trials (N=8,935) were included. Upadacitinib ranked highest for maintenance of clinical remission (SUCRA 93.1%), followed by ustekinumab and vedolizumab. Endoscopic and histologic remission were most sustained with upadacitinib and ustekinumab. Vedolizumab demonstrated the lowest SAE rates (SUCRA 89.7%), followed by ustekinumab and infliximab. Tofacitinib showed favorable efficacy but had higher discontinuation due to adverse events. Subgroup analysis suggested that biologic-naïve patients had better long-term outcomes with infliximab and ustekinumab, while those with prior biologic exposure responded better to upadacitinib. Discussion: Upadacitinib and ustekinumab appear most effective in sustaining long-term clinical and mucosal remission in moderate-to-severe UC. Vedolizumab remains the safest long-term option, reinforcing its role in risk-averse patients. These findings support a personalized, long-term strategy for biologic selection in UC and provide a comprehensive reference for clinical decision-making and guideline development.
Disclosures: Ahmed Hassan indicated no relevant financial relationships. Amr Mostafa indicated no relevant financial relationships. Sara Elsenary indicated no relevant financial relationships. Ahmed Elsayed indicated no relevant financial relationships. Mariam Mohamed indicated no relevant financial relationships. Karim Ahmed indicated no relevant financial relationships. Nehal Kasem indicated no relevant financial relationships. Nancy Bekhit indicated no relevant financial relationships. Zeina Sayed indicated no relevant financial relationships. Mahmoud M. Elsayed indicated no relevant financial relationships.
Ahmed Hassan, MBBCh1, Amr Mostafa, MBBCh2, Sara Elsenary, MBBCh3, Ahmed Elsayed, MBBCh3, Mariam Mohamed, MBBCh4, Karim Ahmed, MBBCh5, Nehal Kasem, MBBCh3, Nancy Bekhit, MBBCh6, Zeina Sayed, MBBCh7, Mahmoud M. Elsayed, MD8. P1119 - Long-Term Outcomes of Biologics in Ulcerative Colitis: A Network Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
