Systematic review with meta-analysis: Medical therapies for treatment of ulcerative proctitis

Aruljothy, Achuthan; Singh, Siddharth; Narula, Neeraj; Moran, Gordon W.; Vuyyuru, Sudheer K.; Hogan, Malcolm; Zayadi, Alexa; MacDonald, John K.; Caron, Benedicte; Danese, Silvio; Peyrin Biroulet, Laurent; Ma, Christopher; Jairath, Vipul

Abstract

Background: Ulcerative proctitis (UP) is a common highly symptomatic form of ulcerative colitis that can be difficult to treat. Aim: To assess the efficacy of medical treatments for UP. Methods: We searched MEDLINE, EMBASE, and CENTRAL on 23 November 2022 for randomised controlled trials (RCTs) of medical therapy for adults with UP. Primary outcomes included induction and maintenance of clinical remission. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for each outcome. Results: We included 53 RCTs (n = 4096) including 46 induction studies (n = 3731) and seven maintenance studies (n = 365). First-line therapies included topical 5-aminosalicylic acid (5-ASA), conventional corticosteroids, budesonide, and oral 5-ASA. Therapy for refractory UP included topical tacrolimus and small molecules. Topical 5-ASA was superior to placebo for induction (RR 2.72, 95% CI 1.94–3.82) and maintenance of remission (RR 2.09, 95% CI 1.26–3.46). Topical corticosteroids were superior to placebo for induction of remission (RR 2.83, 95% CI 1.62–4.92). Topical budesonide was superior to placebo for induction of remission (RR 2.34, 95% CI 1.44–3.81). Combination therapy with topical 5-ASA and topical corticosteroids was superior to topical monotherapy with either agent. Topical tacrolimus was superior to placebo. Etrasimod was superior to placebo for induction (RR 4.71, 95% CI 1.2–18.49) and maintenance of remission (RR 2.08, 95% CI 1.31–3.32). Conclusions: Topical 5-ASA and corticosteroids are effective for active UP. Topical 5-ASA may be effective for maintenance of remission. Tacrolimus may be effective for induction of remission. Etrasimod may be effective for induction and for maintenance of remission. Trials should include UP to expand the evidence base for this under-represented population.

Citation

Aruljothy, A., Singh, S., Narula, N., Moran, G. W., Vuyyuru, S. K., Hogan, M., …Jairath, V. (2023). Systematic review with meta-analysis: Medical therapies for treatment of ulcerative proctitis. Alimentary Pharmacology and Therapeutics, 58(8), 740-762. https://doi.org/10.1111/apt.17666

• Journal Article Type: Review
• Acceptance Date: Jul 28, 2023
• Online Publication Date: Aug 17, 2023
• Publication Date: Oct 1, 2023
• Deposit Date: Oct 25, 2023
• Publicly Available Date: Aug 18, 2024
• Journal: Alimentary Pharmacology and Therapeutics
• Print ISSN: 0269-2813
• Electronic ISSN: 1365-2036
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 58
• Issue: 8
• Pages: 740-762
• DOI: https://doi.org/10.1111/apt.17666
• Keywords: Pharmacology (medical); Gastroenterology; Hepatology
• Public URL: https://nottingham-repository.worktribe.com/output/24585862
• Publisher URL: https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17666