Efficacy and safety of etrolizumab in treatment of moderate to severe ulcerative colitis: A systematic review and meta-analysis

Karam R Motawea; Yomna A Abdelghafar; Yossef H AbdelQadir; Merna M Aboelenein; Nancy Ibrahim; Mohamed M Belal; Rowan H Elhalag; Lina T Khairy; Agyad Bakkour; Ali H H Muwaili; Fatima A A Abdelmajid; Mhd K Albuni; Elias Battikh; Bisher Sawaf; Eman M S Ahmed; Dhuha H H Muwaili; Sarya Swed

doi:10.1002/hsr2.882

Efficacy and safety of etrolizumab in treatment of moderate to severe ulcerative colitis: A systematic review and meta-analysis

Health Sci Rep. 2024 May 9;7(5):e882. doi: 10.1002/hsr2.882. eCollection 2024 May.

Authors

Karam R Motawea¹, Yomna A Abdelghafar¹, Yossef H AbdelQadir¹, Merna M Aboelenein¹, Nancy Ibrahim¹, Mohamed M Belal¹, Rowan H Elhalag¹, Lina T Khairy², Agyad Bakkour³, Ali H H Muwaili⁴, Fatima A A Abdelmajid⁵, Mhd K Albuni⁶, Elias Battikh⁶, Bisher Sawaf⁷, Eman M S Ahmed⁸, Dhuha H H Muwaili⁴, Sarya Swed⁹

Affiliations

¹ Faculty of Medicine Alexandria University Alexandria Egypt.
² The National Ribat University Al-Ribat Sudan.
³ Faculty of Medicine Albaath University Homs Syria.
⁴ Ivano-Frankivsk National Medical University Ivano-Frankivsk Ukraine.
⁵ Department of Internal Medicine University of Medical Sciences and Technology Khartoum Sudan.
⁶ Department of Internal Medicine Damascus University Damascus Syria.
⁷ Department of Internal Medicine Syrian Private University Damascus Syria.
⁸ Department of Obstetrics and Gynecology Nile Valley University Khartoum Sudan.
⁹ Faculty of Medicine Aleppo University Aleppo Syria.

Abstract

Background: Etrolizumab is a promising drug for treating moderate to severe ulcerative colitis.

Aim: The aim of this study was to assess the efficacy and safety of etrolizumab for induction and maintenance of remission in moderate to severe ulcerative colitis.

Methods: We searched the following databases: PUBMED, Web of Science, OVID, and SCOPUS from inception to January 15. Inclusion criteria were any phase 2 and 3 clinical trials that compared etrolizumab with a placebo in treating moderate to severe ulcerative colitis, excluding case reports, animal studies, phase 1 trials, and conference abstracts due to duplication. We used RevMan software (5.4) for the meta-analysis.

Results: Five clinical trials were included in our meta-analysis. The total number of patients included in the study is 1248 patients, 860 patients in the etrolizumab group and 388 patients in the placebo group. In the induction phase, the pooled analyses showed a statistically significant association between etrolizumab and increased clinical remission, and endoscopic remission compared with placebo (risk ratio [RR] = 2.66, 95% confidence interval [CI] = 1.69-4.19, p < 0.0001), and (RR = 2.35, 95% CI = 1.52-3.65, p = 0.0001), respectively. In the maintenance phase, the pooled analyses showed a statistically significant association between etrolizumab and increased histologic remission and endoscopic remission (RR = 2.04, 95% CI = 1.40-2.98, p = 0.0002) and (RR = 1.92, 95% CI = 1.29-2.85, p = 0.001), respectively. No statistically significant difference was observed in adverse events between etrolizumab and placebo in the induction and maintenance phases.

Conclusion: Our results show that etrolizumab is an effective and safe drug for the induction and maintenance of clinical remission in moderate to severe ulcerative colitis patients, as proved by histologic and endoscopic findings. Future randomized trials are still needed to compare etrolizumab to the other agents and further establish its value for the practice.

Keywords: biologic drugs; etrolizumab; ulcerative colitis.