我们进行了更新的系统评价和网络荟萃分析，为 2024 年美国胃肠病学协会 (AGA) 中度至重度溃疡性结肠炎 (UC) 治疗临床指南提供信息。我们截至 2023 年 11 月 21 日检索了多个电子数据库，以了解确定中重度 UC 成人中的随机对照试验，比较不同的先进疗法（肿瘤坏死因子拮抗剂、维多珠单抗、1-磷酸鞘氨醇受体调节剂、白细胞介素 12/23 或选择性白细胞介素 23 拮抗剂和 Janus 激酶 [JAK]抑制剂）与安慰剂或其他活性比较剂相比。我们的主要结局是临床缓解的诱导和维持，次要结局是内镜下的改善。我们使用频率论方法进行了网络荟萃分析，并应用建议、评估、开发和评价分级 (GRADE) 来评估证据的确定性。在排除 JAK 抑制剂作为潜在的一线治疗后（根据美国食品和药物管理局的规定）药物管理局），低确定性证据支持英夫利昔单抗、奥扎尼莫德、risankizumab 和 guselkumab 相对于阿达木单抗和米利克珠单抗，对于中重度 UC 的生物学初治患者通过诱导治疗实现缓解具有临床重要益处，其中 risankizumab 和 ozanimod 被评为诱导临床缓解的最高水平。将 JAK 抑制剂纳入一线治疗后，与除 ozanimod 和 risankizumab 之外的所有其他药物相比，upadacitinib 更有效，且证据质量为低至中等。在既往生物制剂暴露的患者中，乌帕替尼、托法替尼和优特克单抗在实现缓解方面排名最高。利用建议分级、评估、制定和评估来评估证据质量，这一更新的网络荟萃分析将用于提供比较疗效和评估证据质量的信息。定位用于治疗未接触过生物制品和暴露于生物制品的中重度 UC 患者的先进疗法。版权所有 © 2024 AGA Institute。由爱思唯尔公司出版。保留所有权利。

We performed an updated systematic review and network meta-analysis to inform the 2024 American Gastroenterological Association (AGA) Clinical Guidelines on the management of moderate-to-severe ulcerative colitis (UC).We searched multiple electronic databases through November 21, 2023, to identify randomized controlled trials in adults with moderate-to-severe UC, comparing different advanced therapies (tumor necrosis factor antagonists, vedolizumab, sphingosine-1-phosphate receptor modulators, interleukin 12/23 or selective interleukin 23 antagonists, and Janus kinase [JAK] inhibitors) against placebo or another active comparator. Our primary outcomes were induction and maintenance of clinical remission, and our secondary outcome was endoscopic improvement. We performed a network meta-analysis using a frequentist approach and applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to appraise certainty of evidence.After excluding JAK inhibitors as potential first-line treatment (in accordance with the United States Food and Drug Administration), low-certainty evidence supports clinically important benefit with infliximab, ozanimod, risankizumab, and guselkumab over adalimumab and mirikizumab for achieving remission with induction therapy in biologically naïve patients with moderate-to-severe UC, with risankizumab and ozanimod being ranked the highest for induction of clinical remission. With the inclusion of JAK inhibitors as first-line therapy, upadacitinib was more efficacious compared with all other medications except ozanimod and risankizumab, with low- to moderate-certainty evidence. In patients with prior biologic exposure, upadacitinib, tofacitinib, and ustekinumab were ranked highest for achieving remission.Using Grading of Recommendations, Assessment, Development and Evaluation to appraise quality of evidence, this updated network meta-analysis will be used to inform comparative efficacy and positioning of advanced therapies for the treatment of biologic-naïve and biologic-exposed patients with moderate-to-severe UC.Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.