Immunomodulators and advanced therapies for maintenance of remission in Crohn's disease: systematic review and network meta-analysis

Why clinicians should know about it

• Picked for Gastroenterology (top studies of the week, 2 August 2026): Network meta‑analysis of immunomodulators/advanced therapies for Crohn’s remission

Abstract

BACKGROUND: With the range of options available for the treatment of Crohn's disease, therapy selection can be challenging in clinical practice. Comparative efficacy data are needed to clarify the relative position of the increasingly complex portfolio of advanced therapies and guide decision-making. OBJECTIVES: Our aim was to compare all advanced and immunomodulator treatments for efficacy and safety in maintenance of remission. DESIGN: Systematic review and network meta-analysis. DATA SOURCES AND METHODS: We searched databases up to June 2025. Our outcomes were clinical relapse, loss of response, endoscopic relapse, and safety outcomes. We estimated risk ratio (RR) and 95% confidence interval (CI). We used GRADE to assess certainty of results, and surface under the cumulative ranking curve for ranking treatments. RESULTS: A total of 37 randomised controlled trials with 7415 participants were included. Interventions ranged between 22 weeks and 2 years. Adalimumab probably prevents clinical relapse over placebo (RR 0.68, 95% CI 0.54-0.84, Number Needed to Treat (NNT) = 2, moderate effect magnitude). CT-P13 (RR 0.52, 95% CI 0.38-0.71) and infliximab (RR 0.61, 95% CI 0.49-0.76) may prevent clinical relapse. Upadacitinib is more effective than placebo at preventing loss of clinical response (RR 0.64, 95% CI 0.57-0.72, NNT = 2, small magnitude), while CT-P13 (RR 0.46, 95% CI 0.35-0.53, NNT = 1, large magnitude), natalizumab (RR 0.54, 95% CI 0.43-0.68, NNT = 2, moderate magnitude), certolizumab (RR 0.57, 95% CI 0.47-0.7), NNT = 2, moderate magnitude), adalimumab (RR 0.68, 95% CI 0.61-0.75, NNT = 2, small effect magnitude) and ustekinumab (RR 0.73, 95% CI 0.61-0.86, NNT = 2, small magnitude) probably prevent loss of clinical response. Infliximab (RR 0.7, 95% CI 0.59-0.82) and vedolizumab (RR 0.82, 95% CI 0.68-0.99) may prevent loss of clinical response. Endoscopic relapse could not be analysed. Safety evidence is uncertain, but treatments appear generally safe in the short term. CONCLUSION: Adalimumab has moderate certainty for maintaining clinical remission with a moderate effect size. Novel therapies seem to have similar effect sizes, though imprecision due to limited evidence precludes further conclusions. TRIAL REGISTRATION: https://knowledge.lancashire.ac.uk/id/eprint/53237/.

Abstract as published, via PubMed.