Systematic review with meta-analysis: Medical therapies for treatment of ulcerative proctitis

IF 6.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Alimentary Pharmacology & Therapeutics Pub Date : 2023-08-17 DOI:10.1111/apt.17666

Achuthan Aruljothy, Siddharth Singh, Neeraj Narula, Gordon W. Moran, Sudheer K. Vuyyuru, Malcolm Hogan, Alexa Zayadi, John K. MacDonald, Benedicte Caron, Silvio Danese, Laurent Peyrin?Biroulet, Christopher Ma, Vipul Jairath

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Abstract

Background

Ulcerative proctitis (UP) is a common highly symptomatic form of ulcerative colitis that can be difficult to treat.

Aim

To assess the efficacy of medical treatments for UP.

Methods

We searched MEDLINE, EMBASE, and CENTRAL on 23 November 2022 for randomised controlled trials (RCTs) of medical therapy for adults with UP. Primary outcomes included induction and maintenance of clinical remission. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for each outcome.

Results

We included 53 RCTs (n = 4096) including 46 induction studies (n = 3731) and seven maintenance studies (n = 365). First-line therapies included topical 5-aminosalicylic acid (5-ASA), conventional corticosteroids, budesonide, and oral 5-ASA. Therapy for refractory UP included topical tacrolimus and small molecules. Topical 5-ASA was superior to placebo for induction (RR 2.72, 95% CI 1.94–3.82) and maintenance of remission (RR 2.09, 95% CI 1.26–3.46). Topical corticosteroids were superior to placebo for induction of remission (RR 2.83, 95% CI 1.62–4.92). Topical budesonide was superior to placebo for induction of remission (RR 2.34, 95% CI 1.44–3.81). Combination therapy with topical 5-ASA and topical corticosteroids was superior to topical monotherapy with either agent. Topical tacrolimus was superior to placebo. Etrasimod was superior to placebo for induction (RR 4.71, 95% CI 1.2–18.49) and maintenance of remission (RR 2.08, 95% CI 1.31–3.32).

Conclusions

Topical 5-ASA and corticosteroids are effective for active UP. Topical 5-ASA may be effective for maintenance of remission. Tacrolimus may be effective for induction of remission. Etrasimod may be effective for induction and for maintenance of remission. Trials should include UP to expand the evidence base for this under-represented population.

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荟萃分析系统评价：溃疡性直肠炎的药物治疗

背景溃疡性直肠炎（UP）是一种常见的症状严重的溃疡性结肠炎，很难治疗。目的评价药物治疗UP的疗效。方法我们于2022年11月23日在MEDLINE、EMBASE和CENTRAL上搜索成人UP药物治疗的随机对照试验（RCT）。主要结果包括诱导和维持临床缓解。计算每个结果的合并风险比（RR）和95%置信区间（CI）。结果纳入53例随机对照试验（n = 4096），包括46项诱导研究（n = 3731）和7项维护研究（n = 365）。一线治疗包括局部5-氨基水杨酸（5-ASA）、常规皮质类固醇、布地奈德和口服5-ASA。难治性UP的治疗包括外用他克莫司和小分子。局部5-ASA在诱导（RR 2.72，95%CI 1.94–3.82）和维持缓解（RR 2.09，95%CI 1.26–3.46）方面优于安慰剂。局部皮质类固醇在诱导缓解方面优于安慰剂（RR 2.83，95%CI 1.62–4.92）局部皮质类固醇优于任何一种药物的局部单药治疗。局部使用他克莫司优于安慰剂。Etrasimod在诱导（RR 4.71，95%CI 1.2-18.49）和维持缓解（RR 2.08，95%CI 1.31-3.32）方面优于安慰剂。结论局部5-ASA和皮质类固醇对活动性UP有效。局部5-ASA可能对维持病情缓解有效。他克莫司可能对诱导病情缓解有效。Etrasimod可能对诱导和维持病情缓解有效。试验应包括UP，以扩大代表性不足人群的证据基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alimentary Pharmacology & Therapeutics 医学-胃肠肝病学

CiteScore

15.60

自引率

7.90%

发文量

527

审稿时长

3-6 weeks

期刊介绍： Alimentary Pharmacology & Therapeutics is a global pharmacology journal focused on the impact of drugs on the human gastrointestinal and hepato-biliary systems. It covers a diverse range of topics, often with immediate clinical relevance to its readership.