title: Pharmacologic therapies for severe steroid refractory hospitalized ulcerative colitis: A network meta-analysis.
abstract: OBJECTIVE
  A limited option of therapies is available for hospitalized patients with severe steroid refractory ulcerative colitis (UC). Furthermore, there exists a paucity of direct comparisons between them. To provide a comparative evaluation of the efficacy and safety of pharmacologic therapies, we conducted a network meta-analysis combined with a benefit-risk analysis of randomized controlled trials (RCTs) performed in hospitalized patients with severe steroid refractory UC.
  
  
  METHODS
  Electronic databases were searched through November 2015 for RCTs evaluating the efficacy of therapies for severe steroid refractory hospitalized UC. The outcomes were clinical response, colectomy free rate, and severe adverse events leading to discontinuation of therapy. The primary endpoints were the rank of therapies based on network meta-analysis combined with benefit-risk analysis between clinical response and severe adverse events as well as colectomy free rate and severe adverse events.
  
  
  RESULTS
  Eight RCTs of 421 patients were identified. Cyclosporine, infliximab, and tacrolimus as well as placebo were included in our analysis. Network meta-analysis with benefit-risk analysis simultaneously assessing clinical response and severe adverse events demonstrated the rank order of efficacy as infliximab, cyclosporine, tacrolimus, and placebo. Similar analysis for colectomy-free rate and severe adverse events demonstrated the same rank order of efficacy. The differences among infliximab, cyclosporine, and tacrolimus were small in all analyses.
  
  
  CONCLUSIONS
  The results of the present comprehensive benefit-risk assessment using network meta-analysis provide RCT-based evidence on efficacy and safety of infliximab, cyclosporine, and tacrolimus for hospitalized patients with severe steroid refractory UC.
authors.affiliation: Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Yuga
authors.initials: Y
authors.lastname: Komaki
authors.affiliation: Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Fukiko
authors.initials: F
authors.lastname: Komaki
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Dejan
authors.initials: D
authors.lastname: Micic
authors.affiliation: Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.|Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Atsushi
authors.identifier: http://orcid.org/0000-0003-2519-6129
authors.initials: A
authors.lastname: Sakuraba
mesh_terms: D003093:Colitis, Ulcerative / Q000188:drug therapy*; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D016206:Databases, Bibliographic; D006760:Hospitalization; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine; D000069285:Infliximab; D016559:Tacrolimus
keywords: cyclosporine; infliximab; network meta-analysis; tacrolimus; ulcerative colitis