From:  Advancements in therapeutic strategies and drug development for inflammatory bowel diseases

 Selected landmark clinical trials of FDA-approved targeted drugs for IBD.

ClassAgentIndicationStudyPatientsTreatmentPrimary outcome&,#Ref
Anti-TNFαInfliximabCDACCENT I573IFX vs. placebo
  • Clinical remission at Week 30: 39% IFX vs. 21% placebo (P = 0.003)

  • Median time to loss of response at Week 54: 38W IFX vs. 19W placebo (P = 0.002)

[99]
CD fistulizingACCENT II306IFX vs. placebo
  • Median time to loss of response at Week 14: > 40W IFX vs. 14W placebo (P < 0.001)

[100]
UCACT 1364IFX vs. placebo
  • Clinical response at Week 8: 69% IFX vs. 37% placebo (P < 0.001)

[101]
UCACT 2364IFX vs. placebo
  • Clinical response at Week 8: 64% IFX vs. 29% placebo (P < 0.001)

[101]
AdalimumabCDCLASSIC I299ADA vs. placebo
  • Clinical remission at Week 4: 36% ADA vs. 12% placebo (P = 0.001)

[102]
CDCLASSIC II276ADA vs. placebo
  • Clinical remission at Week 56: 79% ADA vs. 44% placebo (P < 0.05)

[103]
CDCHARM854ADA vs. placebo
  • Clinical remission at Weeks 26 or 56, ADA (80/40 mg Week 0/2, 40 mg Q2W) vs. placebo: 40% vs. 17% (P < 0.001) or 36% vs. 12% (P < 0.001)

[104]
CDGAIN325ADA vs. placebo
  • Clinical remission at Week 4: 21% ADA vs. 7% placebo (P < 0.001)

[105]
CDEXTEND135ADA vs. placebo
  • Mucosal healing at Week 52, ADA vs. placebo: 24% vs. 0% (P < 0.001)

  • Clinical remission at Week 52, ADA vs. placebo: 28% vs. 3% (P < 0.001)

[106]
CDADAFI76ADA vs. ADA + ciprofloxacin
  • Fistulas 50% reduction at Week 12: 47% ADA vs. 71% ADA + ciprofloxacin (P = 0.047)

[107]
UCULTRA 1576ADA vs. placebo
  • Clinical remission at Week 8: 18.5% ADA vs. 9.2% placebo (P = 0.031)

[108]
UCULTRA 2494ADA vs. placebo
  • Clinical remission at Week 8: 16.5% ADA vs. 9.3% placebo (P = 0.019)

  • Clinical remission at Week 52: 17.3% ADA vs. 8.5% placebo (P = 0.004)

[109]
Certolizumab pegolCDPRECISE 1662CZP vs. placebo
  • Clinical response at Week 6: 35% CZP vs. 27% placebo (P = 0.02)

  • Clinical response at both Weeks 6 and 26: 23% CZP vs. 16% placebo (P = 0.02)

[110]
CDPRECISE 2668CZP vs. placebo
  • Clinical response at Week 26: 62% CZP vs. 34% placebo (P < 0.001)

[111]
GolimumabUCPURSUIT-SC induction1,064GLM vs. placebo
  • Clinical response at Week 6: 51.0% GLM vs. 30.3% placebo (P < 0.0001)

[112]
UCPURSUIT-Maintenance464GLM vs. placebo
  • Clinical response at Week 54: 49.7% GLM vs. 31.2% placebo (P < 0.001)

[113]
Anti-integrinNatalizumabCDENACT-1905NTZ vs. placebo
  • Clinical response at Week 10: 56% NTZ vs. 49% placebo (P = 0.05)

[114]
CDENACT-2339NTZ vs. placebo
  • Clinical response at Week 36: 61% NTZ vs. 28% placebo (P < 0.001)

[114]
CDENCORE509NTZ vs. placebo
  • Clinical response at Week 8 sustained through Week 12: 48% NTZ vs. 32% placebo (P < 0.001)

[115]
VedolizumabUCGEMINI 1895VDZ vs. placebo
  • Clinical response at Week 6: 47.1% VDZ vs. 25.5% placebo (P < 0.001)

  • Clinical remission at Week 52: 41.8% VDZ vs. 15.9% placebo (P < 0.001)

[116]
CDGEMINI 21,115VDZ vs. placebo
  • Clinical remission at Week 6: 14.5% VDZ vs. 6.8% placebo (P = 0.02)

  • CDAI-100 response at Week 6: 31.4% VDZ vs. 25.7% placebo (P = 0.23)

  • Clinical remission at Week 52: 39.0% VDZ vs. 21.6% placebo (P < 0.001)

[117]
CDGEMINI 3315VDZ vs. placebo
  • Clinical remission at Week 6: 15.2% VDZ vs. 12.1% placebo (P = 0.433)

[118]
CDVISIBLE 2410VDZ vs. placebo
  • Clinical remission at Week 52: 48.0% VDZ vs. 34.3% placebo (P = 0.008)

[119]
UCVARSITY769VDZ vs. ADA
  • Clinical remission at Week 52: 31.3% VDZ vs. 22.5% ADA (P = 0.006)

  • Endoscopic improvement at Week 52: 39.7% VDZ vs. 27.7% ADA (P < 0.001)

[120]
UCVISIBLE 1216VDZ vs. placebo
  • Clinical remission at Week 52: 46.2% VDZ vs. 14.3% placebo (P < 0.001)

[121]
Anti-IL-12/23 (p40)UstekinumabCDUNITI-1741UST vs. placebo

  • Clinical response at Week 6: 33.7% UST vs. 21.5% placebo (P ≤ 0.003)

(intolerance or inadequate response to TNF blockade)

[122]
CDUNITI-2628UST vs. placebo

  • Clinical response at Week 6: 55.5% UST vs. 28.7% placebo (P < 0.001)

(intolerance or inadequate response to conventional therapy)

[122]
CDIM-UNITI397UST vs. placebo
  • Clinical remission at Week 44: 53.1% UST vs. 35.9% placebo (P = 0.005)

[123]
UCUNIFI961UST vs. placebo
  • Clinical remission at Week 8: 15.5% UST vs. 5.3% placebo (P < 0.001)

  • Clinical remission at Week 44: 43.8% UST vs. 24.0% placebo (P < 0.001)

[124]
Anti-IL-23 (p19)RisankizumabCDADVANCE931RZB vs. placebo

  • Clinical remission at Week 12: 42% RZB vs. 25% placebo (P ≤ 0.0001)

  • Endoscopic response at Week 12: 32% RZB vs. 12% placebo (P ≤ 0.0001)

(intolerance or inadequate response to approved biologics or conventional therapy)

[125]
CDMOTIVATE618RZB vs. placebo

  • Clinical remission at Week 12: 40% RZB vs. 20% placebo (P ≤ 0.0001)

  • Endoscopic response at Week 12: 34% RZB vs. 11% placebo (P ≤ 0.0001)

(intolerance or inadequate response to approved biologics)

[125]
CDFORTIFY542RZB vs. placebo
  • Clinical remission at Week 52: 52% RZB vs. 41% placebo, ∆15% [95% CI 5–24]

  • Endoscopic response 47% RZB vs. 22% placebo, ∆28% [95% CI 19–37]

[126]
UCINSPIRE975RZB vs. placebo
  • Clinical remission at Week 12: 20.3% RZB vs. 6.2% placebo (P < 0.001)

  • Endoscopic improvement at Week 12: 36.5% vs. 12.1% placebo (P < 0.001)

[127]
UCCOMMAND548RZB vs. placebo
  • Clinical remission at Week 52: 40.2% (RZB 180 mg SC), 37.6% (RZB 360 mg SC) vs. 25.1% placebo (both P < 0.001)

[127]
CDSEQUENCE527RZB vs. UST
  • Clinical remission at Week 24: 58.6% RZB vs. 39.5% UST

  • Endoscopic remission at Week 48: 31.8% RZB vs. 16.2% UST (P < 0.001)

[128]
MirikizumabCDCD-1679MIRI vs. placebo
  • Clinical remission at Week 52: 53% MIRI vs. 36% placebo (P < 0.001)

  • Endoscopic response at Week 52: 46% MIRI vs. 23% placebo (P < 0.001)

[129]
UCLUCENT-11,162MIRI vs. placebo
  • Clinical remission at Week 12: 24.2% MIRI vs. 13.3% placebo (P < 0.001)

[130]
UCLUCENT-21,073MIRI vs. placebo
  • Clinical remission at Week 52: 49.9% MIRI vs. 25.1% placebo (P < 0.001)

[130]
GuselkumabCDGRAVITI340GUS vs. placebo
  • Clinical remission at Week 12: 56% GUS vs. 22% placebo (P < 0.001)

  • Endoscopic response at Week 12: 34% GUS vs. 15% placebo (P < 0.001)

  • Deep remission (clinical and endoscopic remission) at Week 48: 26% (GUS 100 mg Q8W), 35% (GUS 200 mg Q4W) vs. 4% placebo (pre-specified)

[131]
CDGALAXI-2508GUS vs. placebo or UST
  • Clinical response at Week 12 and clinical remission at Week 48: 55% (GUS 200 mg), 49% (GUS 100 mg) vs. 12% placebo (both P < 0.0001)

  • Clinical response at Week 12 and endoscopic response at Week 48: 38% (GUS 200 mg), 39% (GUS 100 mg) vs. 5% placebo (both P < 0.0001)

[132]
CDGALAXI-3513GUS vs. placebo or UST
  • Clinical response at Week 12 and clinical remission at Week 48: 48% (GUS 200 mg), 47% (GUS 100 mg) vs. 13% placebo (both P < 0.0001)

  • Clinical response at Week 12 and endoscopic response at Week 48: 36% (GUS 200 mg), 34% (GUS 100 mg) vs. 6% placebo (both P < 0.0001)

[132]
UCASTRO418GUS vs. placebo
  • Clinical remission at Week 12: 27.6% GUS vs. 6.5% placebo (P < 0.001)

  • Clinical response at Week 12: 65.6% GUS vs. 34.5% placebo (P < 0.001)

  • Endoscopic improvement at Week 12: 37.3% GUS vs. 12.9% placebo (P < 0.001)

[133]
UCQUASAR701GUS vs. placebo
  • Clinical remission at Week 12: 22.6% GUS vs. 7.9% placebo (P < 0.001)

[134]
JAKiTofacitinibUCOCTAVE Induction 1598TOF vs. placebo

  • Clinical remission at Week 8: 18.5% TOF vs. 8.2% placebo (P = 0.007)

(intolerance or inadequate response to conventional therapy)

[135]
UCOCTAVE Induction 2541TOF vs. placebo

  • Clinical remission at Week 8: 16.6% TOF vs. 3.6% placebo (P < 0.001)

(intolerance or inadequate response to TNF blockade)

[135, 136]
UpadacitinibCDU-EXCEL526UPA vs. placebo
  • Clinical remission at Week 12: 49.5% UPA vs. 29.1% placebo (P < 0.001)

  • Endoscopic response at Week 12: 45.5% UPA vs. 13.1% placebo (P < 0.001)

[137]
CDU-EXCEED495UPA vs. placebo
  • Clinical remission at Week 12: 38.9% UPA vs. 21.1% placebo (P < 0.001)

  • Endoscopic response at Week 12: 34.6% UPA vs. 3.5% placebo (P < 0.001)

[137]
CDU-ENDURE502UPA vs. placebo
  • Clinical remission at Week 52: 47.6% (UPA 30 mg), 37.3% (UPA 15 mg) vs. 15.1% placebo (P < 0.001)

  • Endoscopic response at Week 52: 40.1% (UPA 30 mg), 27.6% (UPA 15 mg) vs. 7.3% placebo (both P < 0.001)

[137, 138]
UCU-ACHIEVE induction474UPA vs. placebo
  • Clinical remission at Week 8: 26% UPA vs. 5% placebo (P < 0.0001)

[139]
UCU-ACHIEVE maintenance451UPA vs. placebo
  • Clinical remission at Week 52: 52% (UPA 30 mg), 42% (UPA 15 mg) vs. 12% placebo (P < 0.0001)

[139]
UCU-ACCOMPLISH522UPA vs. placebo
  • Clinical remission at Week 8: 34% UPA vs. 4% placebo (P < 0.0001)

[139]
S1PR modulatorOzanimodUCJ-TRUE NORTH198OZA vs. placebo
  • Clinical response at Week 12: 61.5% OZA vs. 32.3% placebo (P = 0.0006)

[140]
UCTRUE NORTH1,012OZA vs. placebo
  • Clinical remission at Week 10: 18.4% OZA vs. 6.0% placebo (P < 0.001)

  • Clinical remission at Week 52: 37.0% OZA vs. 18.5% placebo (P < 0.001)

[141]
EtrasimodUCELEVATE UC 12354ETR vs. placebo
  • Clinical remission at Week 12: 25% ETR vs. 15% placebo (P = 0.026)

[142]
UCELEVATE UC 52433ETR vs. placebo
  • Clinical remission at Week 52: 32% ETR vs. 7% placebo (P < 0.0001)

[142]

&: Primary clinical outcomes observed at FDA-approved doses and administration, or as otherwise indicated; #: clinical remission defined as Crohn’s Disease Activity Index (CDAI) score < 150, or total score of ≤ 2 on the Mayo scale and no subscore > 1 on any of the four Mayo scale components; or as a stool frequency score < 1 and not higher than baseline, rectal bleeding score of 0, and endoscopic subscore < 1 without friability. Clinical response defined as a reduction from baseline in the complete Mayo score of ≥ 3 points and ≥ 30%, and a reduction from baseline in the rectal bleeding subscore (RBS) of ≥ 1 point or an absolute RBS of ≤ 1 point. Mucosal healing defined as an absolute subscore for endoscopy of 0 or 1. Endoscopic response defined as > 50% improvement from baseline in Simple Endoscopic Score for Crohn’s Disease (SES-CD) score. Endoscopic remission defined as SES-CD ≤ 4 and a ≥ 2-point reduction from baseline and no subscore greater than 1 in any individual component. Endoscopic improvement defined as subscore of 0 to 1 on the Mayo endoscopic component; ∆: difference between the treatment group and the placebo group. IBD: inflammatory bowel disease; TNF: tumor necrosis factor; CD: Crohn’s disease; IFX: infliximab; UC: ulcerative colitis; ADA: adalimumab; CZP: certolizumab pegol; GLM: golimumab; NTZ: natalizumab; VDZ: vedolizumab; IL: interleukin; UST: ustekinumab; RZB: risankizumab; SC: subcutaneous; MIRI: mirikizumab; GUS: guselkumab; JAKi: Janus kinase inhibitor; TOF: tofacitinib; UPA: upadacitinib; S1PR: sphingosine-1-phosphate receptor; OZA: ozanimod; ETR: etrasimod.