P0859Comparative efficacy and safety of therapies for adult ulcerative colitis: a network meta-analysis

Abstract Background To evaluate the efficacy and safety of mesalazine, glucocorticoids, immunosuppressants, small-molecules, biologics, and fecal microbiota transplantation in treating mild to moderate and moderate to severe ulcerative colitis (UC) in adults. Methods Literature search in Cochrane, Embase, and PubMed databases up to October 2025 identified RCTs involving adult UC patients treated with the aforementioned therapies. Clinical remission and mucosal healing were the primary efficacy outcomes, with adverse events (AEs) and serious AEs as the safety outcomes. A network meta-analysis was conducted using a multivariate consistency model and random-effect meta-regression, with treatment rankings based on the surface under the cumulative ranking curve (SUCRA). Cluster analysis was applied to assess the SUCRA scores for efficacy and safety, identifying the optimal treatment for ulcerative colitis with different disease levels. Results 81 RCTs (39 mild-moderate, 42 moderate-severe), 11,338 UC patients included. Tacrolimus showed the highest clinical response rate (RR 0.25, 95% CI 0.06-0.57; SUCRA, 93.7%) and mucosal healing and mercaptopurine (6-MP) had the highest rank for clinical remission (RR = 0.63, 95%CI 0.55-0.86; SUCRA, 85.8%) but the lowest for AEs (RR = 1.25, 95%CI 1.20-1.80; SUCRA, 14.2%) for mild to moderate UC. However, for moderate to severe ulcerative colitis, Vedolizumab has a high clinical response (RR = 0.29, 95%CI 0.17-0.51; SUCRA, 94.2%) and clinical remission(RR = 0.22, 95%CI 0.15-0.62; SUCRA, 90.3%). Only Vedolizumab reduced AEs, with the highest adverse event ranking (RR = 0.38, 95%CI 0.25-0.79; SUCRA, 95.1%). Infliximab uniquely increased the risk of serious AEs (RR = 1.70, 95%CI 1.52-1.96). Cluster analysis of clinical response and AEs indicated that Tacrolimus was the most effective for mild-to-moderate UC and Vedolizumab was the most effective for moderate-to-severe UC. The study’s conclusions should be cautiously interpreted due to potential biases and heterogeneity Conclusion Tacrolimus was the optimal therapy for mild-to-moderate UC patients, and for moderate-to-severe UC was Vedolizumab through a network meta-analysis that considered both efficacy and safety. However, further comparative studies are needed to enhance clinical decision-making confidence. Conflict of interest: Dr. Chi, Xiaoyan: No conflict of interest Ren, Rongrong: No conflict of interest