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Anti-TNFα trumps other treatments at preventing postoperative Crohn’s disease recurrence

10 Aug 2019
Crohn’s is not the end of the world, as Kathleen Baker’s silver medal proves

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.

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Most Read Articles
4 days ago
Children with high dental anxiety are more likely to develop dental diseases, which, in turn, negatively affect the family’s quality of life, a recent study has found.
2 days ago
Exposure to corticosteroids in patients with autoimmune hepatitis (AIH) appears to contribute to increased risks of cataract, diabetes and bone fractures, a study has found. Notably, the fracture risk is elevated at low doses, while the risk of adverse events overall is dose-dependent and is reversible.
14 Nov 2019
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4 days ago
Supplementation with oral nano vitamin D appears to moderate disease activity and severity grade of patients with active ulcerative colitis (UC), suggests a study, adding that this association is more evident in those achieving a target vitamin D level of 40 ng/mL.