Efficacy and safety of sphingosine 1-phosphate receptor modulators for ulcerative colitis: A systematic review and meta-analysis of randomized controlled trials
Document Type
Review Article
Department
Medical College Pakistan; Biological and Biomedical Sciences
Abstract
Background and aims: Sphingosine 1-phosphate receptor modulators (S1PRMs) are an effective treatment for ulcerative colitis (UC). This review summarizes all available randomized trial data on the efficacy and safety of S1PRM therapy.
Methods: Multiple publication databases were systematically searched for randomized control trials (RCTs) of adults with moderate to severe UC treated with S1PRMs. Random effects meta-analysis was performed. The risk of bias was assessed using the Cochrane Risk-of-Bias 2 tool, and the overall quality of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Results: We identified 7 RCTs (1737 patients) involving the use of S1PRMs for moderate to severe UC. During induction, S1PRM therapy was efficacious when compared with placebo for clinical remission [RR: 2.65 (95% CI: 2.00, 3.53)], clinical response [RR: 1.68 (95% CI: 1.48, 1.91)], endoscopic improvement [RR: 2.17 (95% CI: 1.76, 2.68)], endoscopic normalization [RR: 2.56 (95% CI: 1.58, 3.83)], mucosal healing [RR: 2.88 (95% CI: 1.94, 4.26)], and histologic remission [RR: 2.42 (95% CI: 1.60, 3.66)]. Similar results were seen throughout the maintenance peroid, although fewer data were available to pool; notably, both sustained [RR: 3.57 (95% CI: 1.23, 10.35)] and steroid-free [RR: 2.92 (95% CI: 1.35, 6.33)] remission were significantly increased by S1PRM. There were no significant differences in adverse events [RR: 1.02 (95% CI: 0.90, 1.15)] and infections [RR: 1.15 (95% CI: 0.82, 1.60)] between S1PRM and placebo.
Conclusion: Pooling of RCT data confirms that S1PRM therapy is both effective and safe for patients with moderate to severe UC.
Publication (Name of Journal)
Journal of Clinical Gastroenterology
DOI
10.1097/MCG.0000000000002027
Recommended Citation
Mahmud, O.,
Fatimi, A. S.,
Mahar, M. U.,
Jahangir, A.,
Kashif, A.,
Abbas, M.,
Waljee, A. K.,
Berinstein, J. A.
(2024). Efficacy and safety of sphingosine 1-phosphate receptor modulators for ulcerative colitis: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Gastroenterology, 58(8), 753-763.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_mc/480