Selected landmark clinical trials of FDA-approved targeted drugs for IBD.
| Class | Agent | Indication | Study | Patients | Treatment | Primary outcome&,# | Ref |
|---|---|---|---|---|---|---|---|
| Anti-TNFα | Infliximab | CD | ACCENT I | 573 | IFX vs. placebo |
| [99] |
| CD fistulizing | ACCENT II | 306 | IFX vs. placebo |
| [100] | ||
| UC | ACT 1 | 364 | IFX vs. placebo |
| [101] | ||
| UC | ACT 2 | 364 | IFX vs. placebo |
| [101] | ||
| Adalimumab | CD | CLASSIC I | 299 | ADA vs. placebo |
| [102] | |
| CD | CLASSIC II | 276 | ADA vs. placebo |
| [103] | ||
| CD | CHARM | 854 | ADA vs. placebo |
| [104] | ||
| CD | GAIN | 325 | ADA vs. placebo |
| [105] | ||
| CD | EXTEND | 135 | ADA vs. placebo |
| [106] | ||
| CD | ADAFI | 76 | ADA vs. ADA + ciprofloxacin |
| [107] | ||
| UC | ULTRA 1 | 576 | ADA vs. placebo |
| [108] | ||
| UC | ULTRA 2 | 494 | ADA vs. placebo |
| [109] | ||
| Certolizumab pegol | CD | PRECISE 1 | 662 | CZP vs. placebo |
| [110] | |
| CD | PRECISE 2 | 668 | CZP vs. placebo |
| [111] | ||
| Golimumab | UC | PURSUIT-SC induction | 1,064 | GLM vs. placebo |
| [112] | |
| UC | PURSUIT-Maintenance | 464 | GLM vs. placebo |
| [113] | ||
| Anti-integrin | Natalizumab | CD | ENACT-1 | 905 | NTZ vs. placebo |
| [114] |
| CD | ENACT-2 | 339 | NTZ vs. placebo |
| [114] | ||
| CD | ENCORE | 509 | NTZ vs. placebo |
| [115] | ||
| Vedolizumab | UC | GEMINI 1 | 895 | VDZ vs. placebo |
| [116] | |
| CD | GEMINI 2 | 1,115 | VDZ vs. placebo |
| [117] | ||
| CD | GEMINI 3 | 315 | VDZ vs. placebo |
| [118] | ||
| CD | VISIBLE 2 | 410 | VDZ vs. placebo |
| [119] | ||
| UC | VARSITY | 769 | VDZ vs. ADA |
| [120] | ||
| UC | VISIBLE 1 | 216 | VDZ vs. placebo |
| [121] | ||
| Anti-IL-12/23 (p40) | Ustekinumab | CD | UNITI-1 | 741 | UST vs. placebo |
(intolerance or inadequate response to TNF blockade) | [122] |
| CD | UNITI-2 | 628 | UST vs. placebo |
(intolerance or inadequate response to conventional therapy) | [122] | ||
| CD | IM-UNITI | 397 | UST vs. placebo |
| [123] | ||
| UC | UNIFI | 961 | UST vs. placebo |
| [124] | ||
| Anti-IL-23 (p19) | Risankizumab | CD | ADVANCE | 931 | RZB vs. placebo |
(intolerance or inadequate response to approved biologics or conventional therapy) | [125] |
| CD | MOTIVATE | 618 | RZB vs. placebo |
(intolerance or inadequate response to approved biologics) | [125] | ||
| CD | FORTIFY | 542 | RZB vs. placebo |
| [126] | ||
| UC | INSPIRE | 975 | RZB vs. placebo |
| [127] | ||
| UC | COMMAND | 548 | RZB vs. placebo |
| [127] | ||
| CD | SEQUENCE | 527 | RZB vs. UST |
| [128] | ||
| Mirikizumab | CD | CD-1 | 679 | MIRI vs. placebo |
| [129] | |
| UC | LUCENT-1 | 1,162 | MIRI vs. placebo |
| [130] | ||
| UC | LUCENT-2 | 1,073 | MIRI vs. placebo |
| [130] | ||
| Guselkumab | CD | GRAVITI | 340 | GUS vs. placebo |
| [131] | |
| CD | GALAXI-2 | 508 | GUS vs. placebo or UST |
| [132] | ||
| CD | GALAXI-3 | 513 | GUS vs. placebo or UST |
| [132] | ||
| UC | ASTRO | 418 | GUS vs. placebo |
| [133] | ||
| UC | QUASAR | 701 | GUS vs. placebo |
| [134] | ||
| JAKi | Tofacitinib | UC | OCTAVE Induction 1 | 598 | TOF vs. placebo |
(intolerance or inadequate response to conventional therapy) | [135] |
| UC | OCTAVE Induction 2 | 541 | TOF vs. placebo |
(intolerance or inadequate response to TNF blockade) | [135, 136] | ||
| Upadacitinib | CD | U-EXCEL | 526 | UPA vs. placebo |
| [137] | |
| CD | U-EXCEED | 495 | UPA vs. placebo |
| [137] | ||
| CD | U-ENDURE | 502 | UPA vs. placebo |
| [137, 138] | ||
| UC | U-ACHIEVE induction | 474 | UPA vs. placebo |
| [139] | ||
| UC | U-ACHIEVE maintenance | 451 | UPA vs. placebo |
| [139] | ||
| UC | U-ACCOMPLISH | 522 | UPA vs. placebo |
| [139] | ||
| S1PR modulator | Ozanimod | UC | J-TRUE NORTH | 198 | OZA vs. placebo |
| [140] |
| UC | TRUE NORTH | 1,012 | OZA vs. placebo |
| [141] | ||
| Etrasimod | UC | ELEVATE UC 12 | 354 | ETR vs. placebo |
| [142] | |
| UC | ELEVATE UC 52 | 433 | ETR vs. placebo |
| [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.
We extend our sincere appreciation to Dr. Haifeng Tang for his careful review of the manuscript and expert insights into the chemical aspects discussed herein. We are thankful to Dr. Dafydd Thomas for his careful proofreading of our manuscript.
YZ: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. FS: Conceptualization, Writing—review & editing. Both authors read and approved the submitted version.
Authors YZ and FS, and HT and DT mentioned in the Acknowledgments section are full-time employees of QuantX Biosciences Inc.
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The datasets for this study can be found in PubMed, ClinicalTrials.gov, and Google Scholar.
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