Dataset Information

Strategies for Preventing Endoscopic Recurrence of Crohn's Disease 1 Year after Surgery: A Network Meta-Analysis.

ABSTRACT:

Objective

To assess the benefits of different treatments that aim to prevent the endoscopic recurrence of Crohn's disease (CD) after ileal resection.

Methods

Randomized controlled trials (RCTs) were searched from MEDLINE, Embase, and the Cochrane Central Database. All the included RCTs with an endoscopic recurrence outcome which was defined as Rutgeerts' score???i2 have a duration of more than 1 year. The quality of the included RCTs was assessed by the Cochrane Risk of Bias Tool. Pairwise treatment effects were estimated through a Bayesian random effects network meta-analysis by using the OpenBUGS 1.4 software and reported as odds ratios (ORs) with a 95% credible interval (CI).

Results

Fourteen RCTs (877 participants) were included. Two strategies were superior to placebo for preventing endoscopic recurrence of CD at 1 year after surgery: infliximab (d, -5.475; 95% CI, -10.47 to -1.632) and adalimumab (d, -7.273; 95% CI, -13.84 to -2.585). Nine strategies were not effective: budesnoid, mesalazine (in both high and low dose), azathioprine, Tripterygium wilfordii, mesalazine?+?infliximab, ornidazole, untreated intervention, and Lactobacillus GG.

Conclusions

Except for infliximab and adalimumab, other strategies included in our analysis were not effective for preventing endoscopic recurrence of CD at 1 year after ileal resection.

SUBMITTER: Feng JS

PROVIDER: S-EPMC5467338 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Strategies for Preventing Endoscopic Recurrence of Crohn's Disease 1 Year after Surgery: A Network Meta-Analysis.

Feng Jin-Shan JS Li Jin-Yu JY Chen Xiu-Yan XY Yang Zheng Z Li Shang-Hai SH

Gastroenterology research and practice 20170528

<h4>Objective</h4>To assess the benefits of different treatments that aim to prevent the endoscopic recurrence of Crohn's disease (CD) after ileal resection.<h4>Methods</h4>Randomized controlled trials (RCTs) were searched from MEDLINE, Embase, and the Cochrane Central Database. All the included RCTs with an endoscopic recurrence outcome which was defined as Rutgeerts' score ≥ i2 have a duration of more than 1 year. The quality of the included RCTs was assessed by the Cochrane Risk of Bias Tool. ...[more]

PMID: 28630623

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Project description:Background & aimsThere are several drugs that might decrease the risk of relapse of Crohn's disease (CD) after surgery, but it is unclear whether one is superior to others. We estimated the comparative efficacy of different pharmacologic interventions for postoperative prophylaxis of CD, through a network meta-analysis of randomized controlled trials.MethodsWe conducted a systematic search of the literature through March 2014. We identified randomized controlled trials that compared the abilities of mesalamine, antibiotics, budesonide, immunomodulators, anti-tumor necrosis factor α (anti-TNF) (started within 3 months of surgery), and/or placebo or no intervention to prevent clinical and/or endoscopic relapse of CD in adults after surgical resection. We used Bayesian network meta-analysis to combine direct and indirect evidence and estimate the relative effects of treatment.ResultsWe identified 21 trials comprising 2006 participants comparing 7 treatment strategies. In a network meta-analysis, compared with placebo, mesalamine (relative risk [RR], 0.60; 95% credible interval [CrI], 0.37-0.88), antibiotics (RR, 0.26; 95% CrI, 0.08-0.61), immunomodulator monotherapy (RR, 0.36; 95% CrI, 0.17-0.63), immunomodulator with antibiotics (RR, 0.11; 95% CrI, 0.02-0.51), and anti-TNF monotherapy (RR, 0.04; 95% CrI, 0.00-0.14), but not budesonide (RR, 0.93; 95% CrI, 0.40-1.84), reduced the risk of clinical relapse. Likewise, compared with placebo, antibiotics (RR, 0.41; 95% CrI, 0.15-0.92), immunomodulator monotherapy (RR, 0.33; 95% CrI, 0.13-0.68), immunomodulator with antibiotics (RR, 0.16; 95% CrI, 0.04-0.48), and anti-TNF monotherapy (RR, 0.01; 95% CrI, 0.00-0.05), but neither mesalamine (RR, 0.67; 95% CrI, 0.39-1.08) nor budesonide (RR, 0.86; 95% CrI, 0.61-1.22), reduced the risk of endoscopic relapse. Anti-TNF monotherapy was the most effective pharmacologic intervention for postoperative prophylaxis, with large effect sizes relative to all other strategies (clinical relapse: RR, 0.02-0.20; endoscopic relapse: RR, 0.005-0.04).ConclusionsBased on Bayesian network meta-analysis combining direct and indirect treatment comparisons, anti-TNF monotherapy appears to be the most effective strategy for postoperative prophylaxis for CD.

Dataset Information

Strategies for Preventing Endoscopic Recurrence of Crohn's Disease 1 Year after Surgery: A Network Meta-Analysis.

Objective

Methods

Results

Conclusions

Publications

Strategies for Preventing Endoscopic Recurrence of Crohn's Disease 1 Year after Surgery: A Network Meta-Analysis.

Similar Datasets

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