Michael Miligkos1, Konstantinos Papamichael2, Niels Vande Casteele3, Gerassimos J Mantzaris4, Ann Gils5, Barrett G Levesque6, Elias Zintzaras7. 1. Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece. Electronic address: miligkosmike@yahoo.gr. 2. Department of Gastroenterology, Evaggelismos Hospital, Athens, Greece; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. 3. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Division of Gastroenterology, University of California, San Diego, La Jolla, California. 4. Department of Gastroenterology, Evaggelismos Hospital, Athens, Greece. 5. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. 6. Division of Gastroenterology, University of California, San Diego, La Jolla, California. 7. Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece; Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, Massachusetts.
Abstract
PURPOSE: To compare the benefits and harms of anti-tumor necrosis factor (TNF)-α and anti-integrin agents as induction and maintenance therapy in adult patients with Crohn's disease. METHODS: We searched MEDLINE and the Cochrane Central Register of Controlled Trials from inception through July 2015 for randomized clinical trials in patients with Crohn's disease who reported response or remission with anti-TNF-α or anti-integrin agents administered as induction and/or maintenance therapy. Data on the study population, interventions, outcome measures, adverse events, and study methods were extracted independently by 2 authors. FINDINGS: Among 2503 citations identified, 23 met the eligibility criteria. Random-effects model meta-analyses and network meta-analyses were performed. No statistically significant difference was observed between anti-TNF-α and anti-integrin agents with respect to induction and maintenance of response (odds ratio [OR] = 1.20 [95% CI, 0.73-1.96] from 14 trials and OR = 1.23 [95% CI, 0.50-3.03] from 8 trials, respectively) or remission (OR = 1.13 [95% CI, 0.72-1.76] from 17 trials and OR = 1.18 [95% CI, 0.55-2.50] from 9 trials, respectively). No difference was observed in the indirect comparison of trials that reported results on the subgroup of anti-TNF-α naive patients. The proportions of patients with adverse events, infections, and treatment discontinuations were similar between the agents. IMPLICATIONS: Our indirect treatment comparisons did not find a statistically significant difference between anti-TNF-α and anti-integrin agents for induction or maintenance therapy. In the absence of head-to-head comparisons, it remains unclear which patient is more likely to respond better to any of these agents.
PURPOSE: To compare the benefits and harms of anti-tumor necrosis factor (TNF)-α and anti-integrin agents as induction and maintenance therapy in adult patients with Crohn's disease. METHODS: We searched MEDLINE and the Cochrane Central Register of Controlled Trials from inception through July 2015 for randomized clinical trials in patients with Crohn's disease who reported response or remission with anti-TNF-α or anti-integrin agents administered as induction and/or maintenance therapy. Data on the study population, interventions, outcome measures, adverse events, and study methods were extracted independently by 2 authors. FINDINGS: Among 2503 citations identified, 23 met the eligibility criteria. Random-effects model meta-analyses and network meta-analyses were performed. No statistically significant difference was observed between anti-TNF-α and anti-integrin agents with respect to induction and maintenance of response (odds ratio [OR] = 1.20 [95% CI, 0.73-1.96] from 14 trials and OR = 1.23 [95% CI, 0.50-3.03] from 8 trials, respectively) or remission (OR = 1.13 [95% CI, 0.72-1.76] from 17 trials and OR = 1.18 [95% CI, 0.55-2.50] from 9 trials, respectively). No difference was observed in the indirect comparison of trials that reported results on the subgroup of anti-TNF-α naive patients. The proportions of patients with adverse events, infections, and treatment discontinuations were similar between the agents. IMPLICATIONS: Our indirect treatment comparisons did not find a statistically significant difference between anti-TNF-α and anti-integrin agents for induction or maintenance therapy. In the absence of head-to-head comparisons, it remains unclear which patient is more likely to respond better to any of these agents.
Authors: Konstantinos Papamichael; Adam S Cheifetz; Gil Y Melmed; Peter M Irving; Niels Vande Casteele; Patricia L Kozuch; Laura E Raffals; Leonard Baidoo; Brian Bressler; Shane M Devlin; Jennifer Jones; Gilaad G Kaplan; Miles P Sparrow; Fernando S Velayos; Thomas Ullman; Corey A Siegel Journal: Clin Gastroenterol Hepatol Date: 2019-03-27 Impact factor: 11.382
Authors: Konstantinos Papamichael; Ravy K Vajravelu; Byron P Vaughn; Mark T Osterman; Adam S Cheifetz Journal: J Crohns Colitis Date: 2018-06-28 Impact factor: 9.071
Authors: Jeffrey R Curtis; Xavier Mariette; Cécile Gaujoux-Viala; Andrew Blauvelt; Tore K Kvien; William J Sandborn; Kevin Winthrop; Marc de Longueville; Ivo Huybrechts; Vivian P Bykerk Journal: RMD Open Date: 2019-05-31
Authors: A Blauvelt; C Paul; P van de Kerkhof; R B Warren; A B Gottlieb; R G Langley; F Brock; C Arendt; M Boehnlein; M Lebwohl; K Reich Journal: Br J Dermatol Date: 2020-09-06 Impact factor: 9.302