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Interventions for maintenance of surgically induced remission in Crohn's disease: a network meta-analysis.

ABSTRACT:

SUBMITTER: Iheozor-Ejiofor Z

PROVIDER: S-EPMC6741529 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Interventions for maintenance of surgically induced remission in Crohn's disease: a network meta-analysis.

Iheozor-Ejiofor Zipporah Z Gordon Morris M Clegg Andrew A Freeman Suzanne C SC Gjuladin-Hellon Teuta T MacDonald John K JK Akobeng Anthony K AK

The Cochrane database of systematic reviews 20190912

<h4>Background</h4>Crohn's disease (CD) is a chronic disease of the gut. About 75% of people with CD undergo surgery at least once in their lifetime to induce remission. However, as there is no known cure for the disease, patients usually experience a recurrence even after surgery. Different interventions are routinely used in maintaining postsurgical remission. There is currently no consensus on which treatment is the most effective.<h4>Objectives</h4>To assess the effects and harms of interven ...[more]

PMID: 31513295

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Project description:BackgroundBudesonide is an oral glucocorticoid designed for the treatment of inflammatory bowel disease (IBD) that may reduce systemic adverse events (AEs). This review examined the efficacy and safety of budesonide for the induction and maintenance of clinical remission in Crohn's disease (CD).MethodsMEDLINE, EMBASE, other electronic databases, reference lists and conference proceedings were searched to November 2017 to identify randomized controlled trials of budesonide. Outcomes were the induction and maintenance of remission at eight weeks and one year, respectively, as well as corticosteroid-related AEs and abnormal adrenocorticotropic hormone (ACTH) tests. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random effects models.ResultsThirteen induction and 10 maintenance trials were included. Budesonide 9 mg/day was more effective than placebo (RR 1.93; 95% CI, 1.37-2.73; GRADE: moderate) but less effective than conventional steroids (RR 0.85; 95% CI, 0.75-0.97; GRADE: moderate) to induce remission. Corticosteroid-related AEs occurred less often with induction doses of budesonide than steroids (RR 0.64; 95% CI, 0.54-0.76; GRADE: moderate); budesonide did not increase AEs relative to placebo (RR 0.97; 95% CI, 0.76-1.23; GRADE: moderate). Budesonide 6 mg/day was not different from placebo for maintaining remission (RR 1.13; 95% CI, 0.94-1.35; GRADE: moderate). Both induction (GRADE: low for 3 mg/day, moderate for 9 mg/day) and maintenance budesonide treatment (GRADE: very low for 3 mg/day, low for 6 mg/day) increased the risk of an abnormal ACTH test compared with placebo, but less than conventional steroids (GRADE: very low for both induction and maintenance).ConclusionFor induction of clinical remission, budesonide was more effective than placebo, but less effective than conventional steroids. Budesonide was not effective for the maintenance of remission. Budesonide was safer than conventional steroids, but the long-term effects on the adrenal axis and bone health remain unknown.

Dataset Information

Interventions for maintenance of surgically induced remission in Crohn's disease: a network meta-analysis.

Publications

Interventions for maintenance of surgically induced remission in Crohn's disease: a network meta-analysis.

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