Ye Zhao1, Teng Ma2, Yan-Fang Chen1, Xiao-Yan He1, Li-Hua Ren3, Jian Chen1, Lin Fang1, Jie-Wen Su1, Hong-Jie Zhang1, Rui-Hua Shi4. 1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China. 2. Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province, Nanjing 210029, China. 3. Department of Gastroenterology, Zhangjiagang First People's Hospital, Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou 215006, China. 4. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China; Department of Gastroenterology, Zhongda Hospital, Southeast University, Jiangsu Province, Nanjing 210000, China. Electronic address: ruihuashi@126.com.
Abstract
AIM: To evaluate the efficacy and safety of biologics in the prevention of postoperative recurrence of Crohn's disease. METHODS: Published papers and conference literatures were screened for suitable studies. The main outcome measures were clinical, endoscopic recurrence and adverse events. RESULTS: Seven controlled trials met the inclusion criteria for this meta-analysis. At one year postoperation, the biologic therapies showed significant preventative effects in clinical recurrence (RR=0.36, 95% CI: 0.16-0.79; P=0.01), endoscopic recurrence (RR=0.16, 95% CI: 0.07-0.34; P<0.01) and severe endoscopic recurrence (RR=0.17, 95% CI: 0.04-0.71; P=0.02) when compared with the control arms. Similarly, two years postresection, the use of biologics significantly reduced the risk of clinical, endoscopic and severe endoscopic recurrence relative to the controls. Although the biologic agents were not more effective than azathioprine in preventing clinical recurrence (P=0.14), they were more effective in preventing endoscopic recurrence (RR=0.09, 95% CI: 0.02-0.47; P<0.01). Moreover, administration of the biologics was not associated with any significant difference in the rate of adverse events (RR=1, 95% CI: 0.75-1.34; P=0.99) or severe adverse events (RR=1.03, 95% CI: 0.33-3.26; P=0.96) when compared with controls. CONCLUSION: Biologics are superior to azathioprine and traditional therapies and are not associated with increased adverse events in the postoperative treatment of Crohn's disease.
AIM: To evaluate the efficacy and safety of biologics in the prevention of postoperative recurrence of Crohn's disease. METHODS: Published papers and conference literatures were screened for suitable studies. The main outcome measures were clinical, endoscopic recurrence and adverse events. RESULTS: Seven controlled trials met the inclusion criteria for this meta-analysis. At one year postoperation, the biologic therapies showed significant preventative effects in clinical recurrence (RR=0.36, 95% CI: 0.16-0.79; P=0.01), endoscopic recurrence (RR=0.16, 95% CI: 0.07-0.34; P<0.01) and severe endoscopic recurrence (RR=0.17, 95% CI: 0.04-0.71; P=0.02) when compared with the control arms. Similarly, two years postresection, the use of biologics significantly reduced the risk of clinical, endoscopic and severe endoscopic recurrence relative to the controls. Although the biologic agents were not more effective than azathioprine in preventing clinical recurrence (P=0.14), they were more effective in preventing endoscopic recurrence (RR=0.09, 95% CI: 0.02-0.47; P<0.01). Moreover, administration of the biologics was not associated with any significant difference in the rate of adverse events (RR=1, 95% CI: 0.75-1.34; P=0.99) or severe adverse events (RR=1.03, 95% CI: 0.33-3.26; P=0.96) when compared with controls. CONCLUSION: Biologics are superior to azathioprine and traditional therapies and are not associated with increased adverse events in the postoperative treatment of Crohn's disease.