Background: In the last decade, the introduction of the first anti-tumor necrosis factor
(TNF)-α agent infliximab has revolutionized the treatment of ulcerative colitis (UC). However, this
drug is not a magic bullet since up to 50% of UC patients do not respond (primary failure) or lose
response to infliximab (secondary failure). Hence the demand for novel drugs to fill the unmet medical
Objective: The aim of this review is to discuss the data from randomized controlled trials (RCTs) of
available biological agents for the treatment of moderate-to-severe UC in adults, in order to support
clinical decision making.
Results and Conclusion: New biological agents are now available for the treatment of moderate-tosevere
UC. Adalimumab and golimumab are anti-TNF-α monoclonal antibodies, as is infliximab,
whereas vedolizumab blocks the integrin α4β7/mucosal addressin cell adhesion molucule-1 (MAd-
CAM). Additions to the therapeutic arsenal boost the chances of successful treatment of UC, but
lead to difficulty choosing the most appropriate biological drug: which biologic to use first and when
and how to switch. In the absence of head-to-head trials to answer these questions, a network metaanalysis
of the available RCTs can provide estimates of relative efficacy between interventions.
Other factors, including convenience and satisfaction for the patient, route of administration, the cost
of treatment, and the safety and efficacy profile, should all be considered.