S1723 Comparative Efficacy of IL-12/23 and IL-23 Inhibitors for Maintenance Therapy in Crohn’s Disease: A Systematic Review and Network Meta-Analysis

Introduction: Crohn’s disease is a chronic inflammatory bowel disease requiring long-term treatment to maintain remission and prevent relapse. Biologic therapies targeting interleukin (IL)-12/23 and IL-23 pathways have emerged as effective options for patients with moderate to severe disease. However, direct comparisons between individual IL-12/23 and IL-23 inhibitors are lacking in the current literature, making it challenging to determine their relative efficacy. Methods: We systematically searched PubMed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and ClinicalTrials.gov for randomized clinical trials. A Bayesian network meta-analysis was conducted to compare the efficacy of IL-12/23 and IL-23 inhibitors for maintenance therapy in Crohn’s disease, allowing for indirect comparisons across interventions. Primary outcomes were clinical remission and corticosteroid-free clinical remission. Relative risks (RRs), 95% confidence intervals (CI), and surface under the cumulative ranking (SUCRA) probabilities were calculated to rank treatments according to their likelihood of being the most effective. Results: A total of 2,281 patients were enrolled across 5 clinical trials during the maintenance phase. Among them, 659 were treated with ustekinumab, 63 with guselkumab, 396 with risankizumab, 579 with mirikizumab, and 496 received a placebo. Although no statistically significant differences were observed between the treatment groups and placebo during the maintenance period, SUCRA rankings indicated that guselkumab had the highest rate of clinical remission (73.6%). Risankizumab demonstrated the greatest corticosteroid-free clinical remission rate (RR: 2.37; 95% CI: 1.64–3.42, SUCRA: 88.8%) compared to placebo, and it also showed a statistically significant advantage over ustekinumab (RR: 1.51; 95% CI: 1.26–1.80). Conclusion: Although no statistically significant differences for clinical remission were observed between treatments or vs placebo, all IL-12/23– and IL–23–targeted therapies ranked higher than placebo for corticosteroid-free remission based on SUCRA analysis. Between the treatments, only risankizumab showed a statistically significant benefit over ustekinumab. These findings underscore the potential efficacy of these agents and the need for head-to-head trials to confirm their comparative performance.