S1731 Comparative Study of Efficacy and Safety of Infliximab vs Risankizumab in Moderate to Severe Crohn's Disease: A Systematic Review and Network Meta-Analysis

Introduction: Bayesian network meta-analysis was utilized to compare the efficacy and safety of Infliximab and Risankizumab for treatment of moderate-severe Crohn Disease (CD). Noticeably, Risankizumab was superior in endoscopic remission rate and was non-inferior in clinical remission rate both in induction and maintenance phase. Methods: Systematic literature search via PubMed. Criteria were the following: 1-randomized clinical trials 2-Population adult patients with moderate to severe Crohn Disease 3-Interventions Risankizumab induction dosage is 600 mg and maintenance dosage of 180 mg or 360 mg vs Infliximab 5 mg or 10 mg 4-Outcomes Endoscopic Remission SES- CD <4, Clinical Remission CDAI <150; incidence of any adverse events. The meta-analysis used OpenBUGS or JAGS application for Bayesian analysis, with R being used for data synthesis and visualization. Cochrane risk bias was categorized as Low, High or Unclear. Results: A total of 15 randomized control studies recruited 4579 patients during different periods and various treatment regimens-11 Infliximab trials and 6 Risankizumab trials. Infliximab’s endoscopic induction remission rate of 90.6% was below 97.5% threshold of being significant OR 2.284 95% CrI: 0.457-12.629; while Risankizumab was 99.6% OR 3.452 95% CrI: 1.402-9.088. The between-study heterogeneity I² 15% indicated low to moderate variability in treatment effects across all studies. Risankizumab 72.8% had best treatment Rank1 and Infliximab 62.3% Rank2. Infliximab’s endoscopy remission rate 95.4% during maintenance while Risankizumab was 95.8% with an I² 10%. Infliximab 51.6% and Risankizumab 47.4% had nearly equal outcomes Rank 1. Clinical remission rates during induction of Infliximab 96.2% and Risankizumab 96.6% were not significantly different, but both Infliximab 51.6% and Risankizumab 47.4% were the most effective. Clinical remission rate during maintenance of Infliximab 95.8% compared to Risankizumab 81.6% were not significant, I² 12%. Infliximab adverse events reported 4 lymphoma and 1 tuberculosis. Conclusion: Infliximab had more adverse effects with a yearly cost of $50,510 compared with Risankizumab $41,338 for first year and $29,855/year. Patients using Infliximab warrant regular infusion center visits, while Risankizumab 600 mg IV infusion for induction followed by maintenance therapy 360 mg subcutaneously self-administered at week 12, and every 8 weeks thereafter making it a cost-effective alternative.