@misc{10481/106597,
year = {2025},
month = {7},
url = {https://hdl.handle.net/10481/106597},
abstract = {First-line therapeutic approaches for Crohn's disease include immunosuppressants, aminosalicylates, and corticosteroids.
However, more than one-third of patients are resistant to these treatments and require second-line therapies. Our goal was
to synthesize the evidence on the efficacy and safety of biologics and small molecules for inducing remission in patients with
moderate-to-severe Crohn's disease. A systematic review was conducted by searching for randomized controlled trials on the
target population in PubMed, Scopus, and Web of Science (March 2025). Data synthesis for the outcomes of remission, healthrelated quality of life (HRQoL), and safety was performed using network meta-analyses and surface under the cumulative rating
curve (SUCRA) analyses. The results were presented as risk ratios with 95% credible intervals. We included 55 trials (n=16,113
patients) evaluating 26 biological drugs across 83 doses and six small molecules across 15 doses. Similar results were obtained
in the sensitivity analyses conducted across different measurement time points. Alongside infliximab 5mg/kg (SUCRA 98.6%),
10mg/kg (92%), and 20mg/kg intravenous (91.8%), the recently approved drugs guselkumab 1200mg (83.2%), 600mg (89.2%),
and 200mg intravenous (90.1%), as well as mirikizumab 600mg (91.5%) and 1000mg intravenous (82.4%) presented higher probabilities of disease remission and were associated with increased HRQoL. Drugs such as certolizumab, andecaliximab, fontolizumab, abatacept, and etanercept ranked low for remission (SUCRA<40%) and presented high probabilities of serious adverse
events (over 60%). Small molecules presented an intermediate profile. Inhibitors of interleukin-23 appear to be promising alternatives for the treatment of moderate-to-severe Crohn's disease. Given their safety profile, some anti-TNF drugs should be avoided
in practice.},
organization = {Ministry of Education of Brazil (CAPES)—Finance Code 001},
publisher = {Wiley Periodicals LLC},
keywords = {CINeMA},
keywords = {interleukin inhibitors},
keywords = {monoclonal antibody},
title = {Biological Therapy and Small Molecules for Adults With Crohn's Disease: Systematic Review and Network Meta-Analysis},
doi = {10.1002/phar.70049},
author = {Gorski, Daniela and Luna Lazo, Raul Edison and de Assis de Souza, Dalton and Lobo Borba, Helena Hiemisch and Pontarolo, Roberto and Stumpf Tonin, Fernanda},
}