Immunomodulator therapy does not alter efficacy of anti-TNF for Crohn’s disease
Antitumour necrosis factor (anti-TNF) with or without concurrent immunomodulator (IM) therapy result in comparable outcomes for patients with Crohn’s Disease (CD) or CD-like (CDL) conditions, a new meta-analysis reports.
A total of nine studies were eligible for inclusion in the meta-analysis, resulting in a cumulative sample size of 175 (mean age 26.5 years; 48 percent female). The complete clinical response rates for those treated with anti-TNF with and without IM were 67 percent and 88 percent, respectively.
Pooled analysis from three retrospective studies showed that compared to treatment with concurrent IM, anti-TNF monotherapy was not significantly different in terms of complete clinical response rate (risk ratio [RR], 0.58; 95 percent CI, 0.13–2.54; p=0.5).
The same was true for partial clinical response rates. Cumulative data from two retrospective studies revealed no significant difference between monotherapy and co-therapy with IM (RR, 0.98; 0.52–1.83; p=0.94).
Only one study compared anti-TNF monotherapy and co-therapy with IM in terms of remission rates. All participants achieved endoscopic and deep remission.
In terms of safety, anti-TNF monotherapy was nominally more likely to induce major adverse events than co-therapy with IM, though the association did not reach significance (RR, 3.89; 0.92–16.45; p=0.09). A similar trend was observed for minor adverse events (RR, 3.07; 0.7–13.52; p=0.28).
Stratifying the analysis according to the duration of follow-up did not result in meaningful changes in the primary findings about complete treatment response (follow-up <1 year: RR, 1.17; 0.07–18.96; p=0.91; follow-up >1 year; RR, 0.45; 0.07–2.7; p=0.38).