| Objective:Indirect meta-analysis was conducted to compare the efficacy and safety of infliximab(IFX)and vedolizumab(VDZ)in the treatment of inflammatory bowel disease(IBD),in order to provide reference and basis for the selection of effective biological agents in the treatment of IBD.MethodsAccording to the search formula set by relevant search words,Pub Med,Cochrane Library,Embase,CNKI and other Chinese and foreign literature databases were searched,randomized controlled trials from the establishment of the database to December 2020 were selected,and previous relevant reviews and meta-analyses were read and analyzed,and further search the relevant references.Revman 5.3 software was used to directly compare the data of IFX group or VDZ group with placebo,and indirect treatment comparison(ITC)was used to indirectly compare the relative efficacy and safety of IFX and VDZ.Results:24 randomized,double-blind,placebo-controlled trials were included according to the established criteria,involving a total of 4779 patients with active IBD,including2370 patients with active UC and 2409 patients with active CD.Among UC patients,the IFX group had a higher clinical response rate(RR=2.07,95%CI: 1.81-2.37,p<0.05),clinical response rate(RR=2.62,95%CI:2.10-3.27,p<0.05)and endoscopic healing rate(RR=1.99,95%CI:1.73-2.29,p<0.05)than that of placebo group.The clinical response rate(RR=1.62,95%CI: 1.33-1.97,p<0.05),clinical remission rate(RR=2.39,95%CI:1.89-3.03,p<0.05)and endoscopic healing rate(RR=1.58,95%CI:1.28-1.96,p<0.05)in the VDZ group were also high.Among patients with CD,the clinical response rate was higher in the IFX group compared with placebo(RR=2.42,95%CI:1.73-3.39,p<0.05).The VDZ group also had a high clinical response rate(RR=1.62,95%CI:1.33-1.97,p<0.05)and clinical remission rate(RR=1.82,95%CI:1.47-2.27,p <0.05).There was no significant difference in the incidence of adverse events between the IFX or VDZ groups and placebo groups in the treatment of IBD(RR=1.01,95%CI: 0.95-1.07,p=0.83 / RR =0.99,95%CI: 0.91-1.07,p= 0.74).ITC results showed that the overall clinical response rate(RR=1.28,95%CI:1.01-1.62,p=0.43),overall clinical remission rate(RR=1.10,95%CI:0.80-1.52,p=0.81)and overall endoscopic healing rate(RR=1.26,95%CI:0.98-1.63,p=0.48)in IFX group were higher than those in VDZ group.Subgroup comparison results showed that the clinical response rate(RR=1.34,95%CI:0.85–2.12,p=0.83),clinical remission rate(RR=1.52,95%CI:0.68–3.40,p=0.38)and endoscopic healing rate(RR=1.34,95%CI:0.98–1.83,p=0.68)of UC treated with 5 mg/kg IFX at the induction period of 8 weeks were higher than those of the treatment group treated with 300 mg VDZ for 6 and 10 weeks.During the maintenance treatment of UC,the clinical remission rates at 30 and 54 weeks of 5 mg/kg IFX treatment for UC were lower than those at 52 and 60 weeks of300 mg VDZ treatment for UC(RR=0.90,95%CI:0.58–1.40 p=0.81).The overall clinical remission rate of CD in IFX group(RR=1.33,95%CI:0.89-1.98,p=0.58)was higher than that in VDZ group.Subgroup comparison showed that the clinical remission rates(RR=1.10,95%CI:0.63-1.87,p=0.87)of CD treated with 5 mg/kg IFX for 12 and30 weeks were higher than those treated with 300 mg VDZ for 52 and 60 weeks.The above comparison results were not statistically different.Conclusion:For patients with moderate to severe ulcerative colitis without parenteral manifestations,vedolizumab is recommended as a first-line biological agent and infliximab as a second-line agent.Infliximab is recommended as first-line treatment for moderate to severe Crohn’s disease. |
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