Anti-TNFα trumps other treatments at preventing postoperative Crohn’s disease recurrence
Anti-tumour necrosis factor α (anti-TNFα) agents are better than other conventional therapies at preventing the clinical, endoscopic and histological postoperative recurrence (POR) of Crohn’s disease (CD), reports a recent meta-analysis.
After applying the selection criteria, 14 studies emerged eligible for inclusion in the analysis, ten of which were randomized controlled trials (RCTs) by design. The resulting cumulative sample included 1,224 CD patient. Studies were retrieved from the databases of PubMed, Embase, CENTRAL and Web of Science.
The rate of clinical (odds ratio [OR], 0.508, 95 percent CI, 0.309–0.834; p=0.007), endoscopic (OR, 0.312; 0.199–0.489; p<0.001), severe endoscopic (OR, 0.195, 0.195–0.356; p<0.001) and histological (OR, 0.255, 0.106–0.611) POR was significantly lower in patients who were taking anti-TNFα as opposed to other nonbiological treatments.
In comparison, anti-TNFα therapy was significantly better than thiopurines only in terms of endoscopic POR (OR, 0.392, 0.241–0.639; p<0.001). Head-to-head comparison studies also showed that adalimumab and infliximab resulted in statistically comparable endoscopic POR rates (OR, 0.799, 0.329–1.940; p=0.620).
Eight of the included studies did not stratify patients according to risk groups. In this pooled sample of unselected CD patients, anti-TNFα treatment remained significantly better at preventing clinical (OR, 0.324, 0.158–0.664; p=0.002), endoscopic (OR, 0.225, 0.124–0.409; p<0.001) and severe endoscopic (OR, 0.248, 0.070–0.877) POR.
The relative efficacy of anti-TNFα therapies did not come at the cost of additional safety concerns, according to a pooled analysis of six studies. The rate of adverse (OR, 0.860, 0.457–1.617; p=0.639) and severe adverse (OR, 1.018, 0.641–1.617; p=0.94) events were comparable between patients who received anti-TNFα and other conventional treatments.