We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Systematic Review and Network Meta-Analysis of Medical Therapies to Prevent Recurrence of Post-Operative Crohn's Disease.
- Authors
Burr, Nicholas E; Hall, Barry; Hamlin, P John; Selinger, Christian P; Ford, Alexander C; O'Connor, Anthony
- Abstract
Background and Aims Surgery is an important treatment for Crohn's disease [CD], but recurrence occurs in up to 80% of individuals post-operatively. The efficacy of several drugs to prevent post-operative recurrence has been studied in previous meta-analyses, but a number of randomized controlled trials [RCTs] have recently been published. We therefore performed an updated systematic review and network meta-analysis to investigate this issue. Methods We performed a comprehensive literature search through to July 2018 to identify RCTs investigating the endoscopic and clinical recurrence of CD at 12 months post-operatively. We performed a random-effects network meta-analysis to produce a pooled relative risk [RR] with 95% confidence intervals [CIs]. We ranked the treatments according to their P-score. Results We included 10 RCTs, containing 751 patients, in our primary analysis of endoscopic recurrence of CD at 12 months. Anti-tumour necrosis factor [TNF]-α therapies were significantly better than placebo, either alone [P-score 0.98, RR 0.13; 95% CI 0.04–0.39] or in combination with 5-aminosalicylates [5-ASAs] [P-score 0.81, RR 0.30; 95% CI 0.12–0.75], or 5-nitroimidazoles [P-score 0.75, RR 0.40; 95% CI 0.23–0.69]. Combination therapy with a thiopurine and 5-nitroimidazole was also more effective than placebo [P-score 0.59, RR 0.56; 95% CI 0.40–0.80], as was thiopurine monotherapy [P-score 0.31, RR 0.84; 95% CI 0.74–0.94]. However, neither 5-nitroimidazoles nor 5-ASAs alone were superior to placebo. Conclusions In network meta-analysis, anti-TNF-α therapies alone, or in combination, appear to be the best medications for preventing endoscopic post-operative recurrence of CD.
- Publication
Journal of Crohn's & Colitis, 2019, Vol 13, Issue 6, p693
- ISSN
1873-9946
- Publication type
Article
- DOI
10.1093/ecco-jcc/jjy216