Systematic review and network meta-analysis: evaluating the impact of advanced therapies for moderate-to-severe ulcerative colitis on health-related quality of life

INTRODUCTION: Ulcerative colitis (UC) is a chronic inflammatory disease that impairs health-related quality of life (HRQoL). We evaluated the effect of approved therapies on HRQoL in adults with moderate-to-severe UC. METHODS: We systematically searched Medline, Embase, CENTRAL, and gray literature through December 2024 for randomized controlled trials of approved therapies. The primary outcome was change in Inflammatory Bowel Disease Questionnaire (IBDQ) score during induction and maintenance. Secondary outcomes included changes in Short Form-36 (SF-36) Mental and Physical Component Scores, Work Productivity and Activity Impairment in UC (WPAI-UC), and rates of IBDQ response (≥16-point increase) and remission (score ≥170). Minimal clinically important differences were prespecified. Subgroup analyses based on prior biologic exposure were performed for primary outcome. Frequentist random-effects network meta-analyses were conducted, and confidence in estimates was assessed using the CINeMA (Confidence In Network Meta-Analysis) framework. RESULTS: Twenty-eight RCTs were included; 26 reported HRQoL outcomes during induction and 15 during maintenance. During induction, clinically meaningful improvements in IBDQ were observed with upadacitinib, filgotinib, and guselkumab. During maintenance, upadacitinib 30 mg and vedolizumab showed HRQoL benefits, although clinical meaningfulness was not consistently demonstrated. SF-36 improvements were modest overall, with upadacitinib and vedolizumab showing selective advantages, while WPAI-UC benefits were observed with upadacitinib, vedolizumab, and ustekinumab. Upadacitinib consistently ranked highest in IBDQ response and remission, while other therapies showed variable efficacy across outcomes. DISCUSSION: Advanced therapies vary in their impact on HRQoL, with some demonstrating clinically meaningful improvements in UC. These findings support integrating HRQoL into treatment selection and shared decision-making.