INFLAMMATORY bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic condition requiring long-term treatment and frequent therapy adjustments. Biologic agents targeting specific inflammatory pathways have transformed patient outcomes, and newer agents are emerging. Mirikizumab, a monoclonal antibody that targets the p19 subunit of interleukin-23, has shown potential in clinical trials. A recent meta-analysis assessed its efficacy and safety in IBD, and found that mirikizumab significantly improved both clinical and endoscopic outcomes.
To evaluate the therapeutic value of mirikizumab in IBD, researchers conducted a systematic review and meta-analysis of randomised controlled trials. Major databases: PubMed, Embase, the Cochrane Library, and Web of Science, were searched up to 1 November 2023. Eligible studies involved adult patients with IBD who received mirikizumab. Quality was assessed using the Cochrane risk-of-bias tool, and pooled data were analysed using Stata 15 software.
Three randomised controlled trials encompassing a total of 1,602 participants met the inclusion criteria. Mirikizumab was associated with a significant improvement in clinical remission (risk ratio [RR]: 2.11; 95% CI: 1.74–2.55) and clinical response (RR: 1.68; 95% CI: 1.50–1.89). Further, patients treated with mirikizumab showed enhanced endoscopic remission (RR: 1.95; 95% CI: 1.65–2.31) and histologic-endoscopic mucosal improvement (RR: 1.92; 95% CI: 1.60–2.32). These findings suggest mirikizumab may offer consistent and meaningful benefits across key clinical endpoints in IBD management.
While this meta-analysis supports the use of mirikizumab in IBD, the findings are based on a limited number of studies and relatively short follow-up durations. Long-term safety data and real-world evidence are needed before widespread adoption. Clinicians should remain cautious and consider individual patient profiles when introducing novel biologics. Nevertheless, mirikizumab appears to be a promising addition to the therapeutic landscape of IBD and may soon play a pivotal role in clinical practice.
Reference
Chen X et al. Efficacy and safety of mirikizumab in the treatment of inflammatory bowel disease: A meta-analysis. Medicine (Baltimore). 2025;104(17): e42123
