Motoi Uchino1, Hiroki Ikeuchi1, Keisuke Hata2, Tomohiro Minagawa1, Yuki Horio1, Ryuichi Kuwahara1, Shiro Nakamura3, Kenji Watanabe4, Masayuki Saruta5, Toshimitsu Fujii6, Taku Kobayashi7, Ken Sugimoto8, Fumihito Hirai9, Motohiro Esaki10, Sakiko Hiraoka11, Katsuyoshi Matsuoka12, Shinichiro Shinzaki13, Minoru Matsuura14, Nagamu Inoue15, Hiroshi Nakase16, Mamoru Watanabe6. 1. Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. 2. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. 3. Department of Internal Medicine II, Osaka Medical College Hospital, Osaka, Japan. 4. Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. 5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. 6. Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan. 7. Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan. 8. First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. 9. Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 10. Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan. 11. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan. 12. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan. 13. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Osaka, Japan. 14. Department of Gastroenterology and Hepatology, School of Medicine, Kyorin University, Tokyo, Japan. 15. Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan. 16. Department of Gastroenterology and Hepatology, School of Medicine, Sapporo Medical University, Sapporo, Japan.
Abstract
BACKGROUND AND AIM: Anti-tumor necrosis factor (TNF) α agents are now well known to function as effective treatments for Crohn's disease (CD). Several meta-analyses have revealed the efficacy of anti-TNF therapy for preventing recurrence after surgery; however, the efficacies reported in some prospective studies differed according to the outcomes. Moreover, adverse events (AEs) were not well evaluated. We conducted this systematic review and meta-analysis to evaluate both the efficacy of anti-TNF therapy after stratification by the outcome of interest and the AEs. METHODS: We performed a systematic literature review of studies investigating anti-TNF therapy, CD, and postoperative recurrence. Meta-analyses were performed for endoscopic and clinical recurrence and AEs. RESULTS: A total of 570 participants, including 254 patients in the intervention group and 316 patients in the control group, in eight studies, were analyzed for recurrence. Based on the results of the meta-analysis, the efficacies of anti-TNF therapy at preventing endoscopic and clinical recurrence were as follows: relative risk (RR) 0.34, 95% confidence interval (CI) 0.22-0.53 and RR 0.60, 95% CI 0.36-1.02, respectively. The RR of AEs with anti-TNF therapy was 1.75 (95% CI 0.81-3.79). CONCLUSIONS: Anti-TNF therapy after surgery for CD displays efficacy at preventing endoscopic recurrence for 1-2 years, without increasing the incidence of AEs. However, clinical recurrence was not significantly reduced. The efficacy of postoperative anti-TNF therapy may differ in terms of the outcomes, which include long-term prevention, the avoidance of further surgery, and cost-effectiveness.
BACKGROUND AND AIM: Anti-tumor necrosis factor (TNF) α agents are now well known to function as effective treatments for Crohn's disease (CD). Several meta-analyses have revealed the efficacy of anti-TNF therapy for preventing recurrence after surgery; however, the efficacies reported in some prospective studies differed according to the outcomes. Moreover, adverse events (AEs) were not well evaluated. We conducted this systematic review and meta-analysis to evaluate both the efficacy of anti-TNF therapy after stratification by the outcome of interest and the AEs. METHODS: We performed a systematic literature review of studies investigating anti-TNF therapy, CD, and postoperative recurrence. Meta-analyses were performed for endoscopic and clinical recurrence and AEs. RESULTS: A total of 570 participants, including 254 patients in the intervention group and 316 patients in the control group, in eight studies, were analyzed for recurrence. Based on the results of the meta-analysis, the efficacies of anti-TNF therapy at preventing endoscopic and clinical recurrence were as follows: relative risk (RR) 0.34, 95% confidence interval (CI) 0.22-0.53 and RR 0.60, 95% CI 0.36-1.02, respectively. The RR of AEs with anti-TNF therapy was 1.75 (95% CI 0.81-3.79). CONCLUSIONS: Anti-TNF therapy after surgery for CD displays efficacy at preventing endoscopic recurrence for 1-2 years, without increasing the incidence of AEs. However, clinical recurrence was not significantly reduced. The efficacy of postoperative anti-TNF therapy may differ in terms of the outcomes, which include long-term prevention, the avoidance of further surgery, and cost-effectiveness.
Authors: Shin Jeong Pak; Young Il Kim; Yong Sik Yoon; Jong Lyul Lee; Jung Bok Lee; Chang Sik Yu Journal: World J Gastroenterol Date: 2021-11-07 Impact factor: 5.742