S1967 Etrolizumab as Induction and Maintenance Therapy in Patients With Moderately to Severely Active Ulcerative Colitis: A Systematic Review and Meta-Analysis

Introduction: The treatment of ulcerative colitis remains crucial, and new advances in biologic treatments have further advanced the field. Etrolizumab, an anti-β7 integrin monoclonal antibody, has shown promising results in recent clinical trials. We aim in this meta-analysis to evaluate its efficacy as an induction and maintenance treatment option. Methods: On November 15, 2024, a data search was conducted using PubMed, Scopus, and the Cochrane Library. Our inclusion criteria were any controlled clinical trials comparing the use of Etrolizumab to placebo in moderate-to-severe ulcerative colitis. The studied outcomes were clinical response, clinical remission, endoscopic improvements, endoscopic remission, and histologic remission. We used the odds ratio with the 95% confidence interval to estimate the effect size. A random-effects model was used. Results: Out of 354 articles screened, only 5 were eligible, with a total of 1808 patients. Etrolizumab had a significant clinical response compared to placebo with an odds ratio of 1.60 [CI: 1.23 to 2.09, P < 0.001]. Clinical remission was evaluated in both the induction and maintenance groups, and it was significantly higher in the induction group with an odds ratio of 2.85 [CI: 1.63 to 4.99, P < 0.001]. However, there was no significant difference in the maintenance group [OR: 1.43, CI: 0.91 to 2.23, P = 0.12]. In our evaluation of endoscopic improvement, etrolizumab showed significant improvement in both the induction and maintenance groups, with an odds ratio of 1.72 [CI: 1.24 to 2.40, P = 0.001] and 2.09 [CI: 1.37 to 3.20, P < 0.001], respectively. Similar results were observed for endoscopic remission, both the induction and maintenance groups had significant results, with an odds ratio of 2.50 [1.52 to 4.12, P < 0.001] and 2.27 [1.39 to 3.70, P = 0.001], respectively. Finally, histologic remission was only significant for the maintenance group. The odds ratios for induction and maintenance were 1.93 [CI: 1.01 to 3.68, P = 0.05] and 2.67 [CI: 1.61 to 4.41, P < 0.001], respectively. Conclusion: Etrolizumab is an effective option for both induction and maintenance treatment of moderate-to-severe ulcerative colitis. It has a positive impact on clinical response and remission, as well as on endoscopic and histologic endpoints.