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- Title
Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn's disease.
- Authors
Ungaro, Ryan C; Aggarwal, Saurabh; Topaloglu, Ozlem; Lee, Wan‐Ju; Clark, Ryan; Colombel, Jean‐Frederic
- Abstract
Summary: Background: There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim: To perform a systematic review and meta‐analysis to assess the impact of early biologic use in the treatment of CD. Methods: PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top‐down) was compared with a conventional step‐up strategy. Random‐effects meta‐analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top‐down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step‐up treatment strategy). Results: A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow‐up of 64 weeks (range 10‐416). Meta‐analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI: 1.69‐2.60], n = 2763, P <.00001), lower relapse rates (OR 0.31 [95% CI: 0.14‐0.68], n = 596, P =.003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78‐3.16], n = 994, P <.00001) compared with late/conventional management. Conclusions: Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real‐world settings.
- Subjects
CROHN'S disease; META-analysis; INFLAMMATORY bowel diseases; DISEASE remission; DISEASE duration
- Publication
Alimentary Pharmacology & Therapeutics, 2020, Vol 51, Issue 9, p831
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.15685