Paschalis Paschos1,2, Anastasia Katsoula1, Georgia Salanti3, Olga Giouleme4, Eleni Athanasiadou1, Apostolos Tsapas1,5. 1. Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. First Department of Internal Medicine, "Papageorgiou" Hospital, Thessaloniki, Greece. 3. Institute of Social and Preventive Medicine & Clinical Trials Unit, University of Bern, Bern, Switzerland. 4. Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. 5. Harris Manchester College, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: Patient-reported outcomes are important in the assessment of efficacy of intervention for ulcerative colitis (UC). AIM: To compare the impact of interventions for moderate-to-severe UC on health-related quality of life (HRQL). METHODS: We searched Medline, Embase, CENTRAL and grey literature sources through October 2017. We included randomised controlled trials (RCTs) that compared infliximab, adalimumab, golimumab, vedolizumab or tofacitinib to each other or placebo. Outcomes included the change in quality of life scores and the proportion of patients with improvement in quality of life. We performed random-effect pairwise and network meta-analysis. We assessed confidence in estimates using the CINeMA (Confidence in Network Meta-Analysis) framework. RESULTS: Fourteen RCTs assessed HRQL using the Inflammatory Bowel Disease Questionnaire (IBDQ) (14 trials), the Short Form questionnaire-36 (SF-36) (seven trials) or the European Quality of Life-5 Dimensions questionnaire (EQ-5D) (three trials). At induction (13 trials), low to very low confidence evidence suggested that all agents significantly improved both generic and disease-specific HRQL scores compared to placebo. However, only infliximab (MD 18.58; 95% CI 13.19-23.97) and vedolizumab (MD 18.00; 95% CI 11.08-24.92) showed clinically meaningful improvement in IBDQ score. Differences among individual interventions were imprecise. For maintenance (four trials), very low confidence evidence suggested that vedolizumab, tofacitinib and adalimumab maintained improvement in HRQL. CONCLUSIONS: Induction treatment with infliximab, adalimumab, golimumab, vedolizumab or tofacitinib improves quality of life compared to placebo. Evidence on maintenance therapy is sparse and uncertain. Head-to-head comparisons could enhance confidence in conclusions about differences between drugs in terms of HRQL.
BACKGROUND:Patient-reported outcomes are important in the assessment of efficacy of intervention for ulcerative colitis (UC). AIM: To compare the impact of interventions for moderate-to-severe UC on health-related quality of life (HRQL). METHODS: We searched Medline, Embase, CENTRAL and grey literature sources through October 2017. We included randomised controlled trials (RCTs) that compared infliximab, adalimumab, golimumab, vedolizumab or tofacitinib to each other or placebo. Outcomes included the change in quality of life scores and the proportion of patients with improvement in quality of life. We performed random-effect pairwise and network meta-analysis. We assessed confidence in estimates using the CINeMA (Confidence in Network Meta-Analysis) framework. RESULTS: Fourteen RCTs assessed HRQL using the Inflammatory Bowel Disease Questionnaire (IBDQ) (14 trials), the Short Form questionnaire-36 (SF-36) (seven trials) or the European Quality of Life-5 Dimensions questionnaire (EQ-5D) (three trials). At induction (13 trials), low to very low confidence evidence suggested that all agents significantly improved both generic and disease-specific HRQL scores compared to placebo. However, only infliximab (MD 18.58; 95% CI 13.19-23.97) and vedolizumab (MD 18.00; 95% CI 11.08-24.92) showed clinically meaningful improvement in IBDQ score. Differences among individual interventions were imprecise. For maintenance (four trials), very low confidence evidence suggested that vedolizumab, tofacitinib and adalimumab maintained improvement in HRQL. CONCLUSIONS: Induction treatment with infliximab, adalimumab, golimumab, vedolizumab or tofacitinib improves quality of life compared to placebo. Evidence on maintenance therapy is sparse and uncertain. Head-to-head comparisons could enhance confidence in conclusions about differences between drugs in terms of HRQL.
Authors: Hamed Khalili; Åsa H Everhov; Jonas Halfvarson; Jonas F Ludvigsson; Johan Askling; Pär Myrelid; Jonas Söderling; Ola Olen; Martin Neovius Journal: Aliment Pharmacol Ther Date: 2020-07-03 Impact factor: 9.524
Authors: Quentin J Pittman; Mark G Swain; Keith A Sharkey; Nina L Cluny; Kewir D Nyuyki; Wagdi Almishri; Lateece Griffin; Benjamin H Lee; Simon A Hirota Journal: J Neuroinflammation Date: 2022-04-04 Impact factor: 8.322