Comparative assessment of budesonide-MMX and mesalamine in active, mild-to-moderate ulcerative colitis: A systematic review and network meta-analysis.
Adult
Anti-Inflammatory Agents, Non-Steroidal
/ administration & dosage
Budesonide
/ administration & dosage
Colitis, Ulcerative
/ drug therapy
Delayed-Action Preparations
Glucocorticoids
/ administration & dosage
Humans
Mesalamine
/ administration & dosage
Randomized Controlled Trials as Topic
Severity of Illness Index
Treatment Outcome
budesonide-MMX, mesalamine, ulcerative colitis
Journal
British journal of clinical pharmacology
ISSN: 1365-2125
Titre abrégé: Br J Clin Pharmacol
Pays: England
ID NLM: 7503323
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
18
12
2018
revised:
03
06
2019
accepted:
20
06
2019
pubmed:
4
7
2019
medline:
24
9
2020
entrez:
4
7
2019
Statut:
ppublish
Résumé
The comparative efficacy, safety and tolerability of budesonide-MMX and oral mesalamine in active, mild-to-moderate ulcerative colitis (UC) are unclear. We conducted a network meta-analysis to fill this evidence gap. We searched PubMed, Scopus, Embase, the Cochrane Library, clinical trial registries, regulatory agencies' websites and international conference proceedings, up to July 2018, to identify randomized controlled trials of adult patients with active, mild-to-moderate UC, comparing budesonide-MMX or mesalamine against placebo, or against each other, or different dosing strategies, for induction of remission. Two reviewers independently abstracted study data and outcomes, and assessed each trial's risk-of-bias. We identified and synthesized evidence from 15 eligible trials including 4083 participants. Budesonide-MMX 9 mg/day and mesalamine >2.4 g/day had similar efficacy for induction of clinical and endoscopic remission (OR = 0.97; 0.59-1.60), both showing superiority over placebo (OR = 2.68; 1.75-4.10, and OR = 2.75; 1.94-3.90, respectively). Furthermore, mesalamine >2.4 g/day was more efficacious than mesalamine 1.6-2.4 g/day (odds ratio = 1.27; 1.03-1.56). Secondary analyses showed that mesalamine >2.4 g/day ranks at the top among comparator treatments regarding safety (serious adverse events; surface under the cumulative ranking area [SUCRA] 79.2%) and tolerability (treatment discontinuations or withdrawals from the study due to adverse events; SUCRA 96.7%). There was no evidence of inconsistency, while heterogeneity between studies and risk of publication bias were low. Budesonide-MMX and mesalamine >2.4 g/day had similar efficacy for induction of clinical and endoscopic remission in active, mild-to-moderate UC; however, mesalamine >2.4 g/day showed better tolerability. Further high-quality research is warranted.
Identifiants
pubmed: 31269287
doi: 10.1111/bcp.14051
pmc: PMC6783624
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Delayed-Action Preparations
0
Glucocorticoids
0
Mesalamine
4Q81I59GXC
Budesonide
51333-22-3
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2244-2254Informations de copyright
© 2019 The British Pharmacological Society.
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