Meta Analysis Of Clinical Efficacy And Safety Of IL-23 Antagonists In The Treatment Of Moderate And Severe Crohn’s Disease

Objective: To investigate the efficacy and safety of IL-23 antagonists in the treatment of moderate and severe Crohn’s disease.Methods: By searching PubMed,Embase,Web of Science,Cochrane Library,China National Knowledge Internet,VIP,China Biomedical Literature and Wanfang database,the search time is from establishment to December 2022.According to the inclusion and exclusion criteria,randomized controlled trials on the efficacy and safety of IL-23 antagonists in the treatment of moderate and severe CD patients were screened,and the relevant data were extracted after literature quality evaluation.The process was completed independently by two researchers.The data included in the literature were statistically analyzed by R language software,and the stability of the results and possible sources of heterogeneity were evaluated by sensitivity analysis.Funnel chart,Egger’s test and Begg’s test were used to evaluate the publication bias of the results.Result: A total of 12 randomized controlled trials were included,including 6289 subjects,4249 in the experimental group and 2040 in the placebo group.Studies have shown that in terms of clinical efficacy,the incidences of induction phase clinical response[OR:1.79,95% CI(1.46,2.18)],induction phase clinical remission[OR:2.16,95% CI(1.60,2.90)],induction phase endoscopic response[OR:2.76,95%CI(1.65,4.63)],induction endoscopic remission [OR:2.66,95% CI(1.13,6.25)],maintenance endoscopic response [OR:1.99,95% CI(1.05,3.77)],maintenance endoscopic remission [OR:3.56,95% CI(2.56,4.93)] and clinical deep remission [OR:3.29,95% CI(2.22,4.89)] of IL-23 antagonists in the treatment of moderate and severe CD were significantly higher than those in the placebo group,and the differences were statistically significant,but some of the results were not robust.The incidence of clinical response [OR:1.33,95% CI(0.72,2.47)] and clinical remission [OR:1.11,95% CI(0.51,2.39)] in maintenance period was also higher than that in placebo group,but the difference was not statistically significant.In terms of safety,the total incidence of severe adverse events [OR:0.50,95% CI(0.36,0.69)] in moderate and severe CD treated with IL-23 antagonists was significantly lower than that in placebo group,and the difference was statistically significant.The total adverse reactions [OR:0.72,95% CI(0.47,1.12)],total infection events [OR:0.87,95% CI(0.47,1.59)],total severe infection events [OR:0.44,95% CI(0.08,2.44)] and total adverse events [OR:0.78,95% CI(0.50,1.21)] of moderate and severe CD treated with IL-23 antagonist were lower than those in placebo group,but the difference was not statistically significant.Conclusion: IL-23 antagonists can improve the clinical efficacy in the induction and maintenance period of moderate and severe CD patients,and the safety is high.