Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34874
Title: Efficacy and safety of biologics in primary sclerosing cholangitis with inflammatory bowel disease: A systematic review and meta-analysis.
Austin Authors: Shah, Ayesha;Jones, Michael P;Callaghan, Gavin;Fairlie, Thomas;Ma, Xiaomin;Culver, Emma L;Stuart, Katherine;De Cruz, Peter P ;O'Beirne, James;Tabibian, James H;Dignass, Axel;Canbay, Ali;Gores, Gregory J;Holtmann, Gerald J
Affiliation: The University of Queensland, Faculty of Medicine, Australia.;Department of Gastroenterology & Hepatology, Princess Alexandra Hospital.;Translational Research Institute, Queensland, Australia.;AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health.
AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health.;Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.
Department of Gastroenterology & Hepatology, Princess Alexandra Hospital.
The University of Queensland, Faculty of Medicine, Australia.;Department of Gastroenterology & Hepatology, Princess Alexandra Hospital.;Translational Research Institute, Queensland, Australia.;AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health.
The University of Queensland, Faculty of Medicine, Australia.;Department of Gastroenterology & Hepatology, Princess Alexandra Hospital.
Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.;NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.
The University of Queensland, Faculty of Medicine, Australia.;Department of Gastroenterology & Hepatology, Princess Alexandra Hospital.
Gastroenterology and Hepatology
University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.;Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany.
Department of Medicine, University Hospital of the Ruhr-University Bochum, Germany.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
The University of Queensland, Faculty of Medicine, Australia.;Department of Gastroenterology & Hepatology, Princess Alexandra Hospital.;Translational Research Institute, Queensland, Australia.;AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health.
Issue Date: 1-Jan-2024
Date: 2024
Publication information: Hepatology Communications 2024-01-01; 8(1)
Abstract: Primary sclerosing cholangitis (PSC) is an immune-mediated, chronic cholestatic liver disease. Currently, liver transplantation is the only established life-saving treatment. Several studies have evaluated the effect of different biologic therapies on PSC with inconclusive findings. We conducted a systematic review and meta-analysis to assess the effects of biologics in PSC and associated inflammatory bowel disease (IBD). MEDLINE, Scopus, and Embase were searched up to July 31, 2023, for studies reporting the effects of biologics in patients with PSC-IBD. Effects of biologic therapy on alkaline phosphatase, total bilirubin, ulcerative colitis response score, and adverse events were calculated and expressed as standardized difference of means (SMD), proportions, and 95% CI using a random-effects model. Six studies, including 411 PSC-IBD patients who received biologics, were included. Biologic treatment was associated with no change in alkaline phosphatase (SMD: 0.1, 95% CI: -0.07 -0.17, p=0.43), but a small and statistically significant increase in total bilirubin (SMD: 0.2, 95% CI: 0.05-0.35, p<0.01). 31.2% (95% CI: 23.8-39.7) of patients with IBD achieved endoscopic response, and there was a significant improvement in ulcerative colitis response score (SMD: -0.6,95% CI: -0.88 to 0.36, p<0.01). Furthermore, 17.6% (95% CI: 13.0-23.5) of patients experienced adverse events severe enough to discontinue therapy, and 29.9% (95% CI: 25.2-34.8) had a loss of response to biologics. Treatment of patients with PSC-IBD with biologics (vedolizumab, infliximab, and adalimumab) was not associated with improvement of biochemical markers of cholestasis. Biologics are effective in treating the colitis associated with PSC. Vedolizumab was associated with worsening liver enzymes in contrast to other biologics, a finding that warrants further study.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34874
DOI: 10.1097/HC9.0000000000000347
ORCID: 0000-0003-0710-1691
0000-0002-0206-2358
Journal: Hepatology Communications
PubMed URL: 38206197
ISSN: 2471-254X
Type: Journal Article
Subjects: Colitis, Ulcerative/drug therapy
Cholangitis, Sclerosing/complications
Cholangitis, Sclerosing/drug therapy
Inflammatory Bowel Diseases/complications
Inflammatory Bowel Diseases/drug therapy
Biological Products/adverse effects
Appears in Collections:Journal articles

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