Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Medical therapies to prevent relapse of Crohn's disease after surgery: a systematic review and network meta-analysis.
СтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод в очереди
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Gefen Rachel, Parnasa Shani Y, Emile Sameh Hany, Horesh Nir, Dourado Justin, Garoufalia Zoe, Wignakumar Anjelli, Boutros Marylise, Wexner Steven D
Аннотация
BACKGROUND: Postoperative recurrence of Crohn's disease is common. Prophylactic medical treatment against recurrence is advocated, but the most effective regimen is still debatable. This network meta-analysis aimed to compare different types of medical treatments for trying to prevent Crohn's disease recurrence.
METHODS: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review searched PubMed and Scopus for randomized controlled trials in the last 20 years comparing ≥2 medical treatments to prevent recurrence after surgery in patients with Crohn's disease. The main outcomes were endoscopic recurrence, clinical recurrence, and severe adverse events. Risk of bias was assessed using the risk of bias 2 tool.
RESULTS: A total of 24 trials incorporating 2107 patients were reviewed (aged 16-75 years; 51.2% male); 16 trials were included in the network meta-analysis. Adalimumab had significantly lower odds of endoscopic recurrence than did aminosalicylic acid (ASA) (odds ratio [OR], 0.08; 95% CI, 0.02-0.33), azathioprine (OR, 0.16; 95% CI, 0.05-0.54), probiotics (OR, 0.08; 95% CI, 0.012-0.52), or no treatment/placebo (OR, 0.068; 95% CI, 0.017-0.27) and was also associated with significantly lower odds of clinical recurrence than ASA (OR, 0.13; 95% CI, 0.036-0.46), azathioprine (OR, 0.24; 95% CI, 0.08-0.73), and no treatment/placebo (OR, 0.13; 95% CI, 0.035-0.5). Overall, adalimumab was the highest ranked with the lowest likelihood of endoscopic or clinical recurrence.
CONCLUSION: Compared with no treatment or placebo, only adalimumab and infliximab were associated with significantly lower odds of clinical and endoscopic recurrence. This systematic review found that adalimumab had the highest rank in prophylaxis against endoscopic and clinical recurrence of Crohn's disease after surgery; however, it was associated with a higher likelihood of developing severe adverse events.
METHODS: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review searched PubMed and Scopus for randomized controlled trials in the last 20 years comparing ≥2 medical treatments to prevent recurrence after surgery in patients with Crohn's disease. The main outcomes were endoscopic recurrence, clinical recurrence, and severe adverse events. Risk of bias was assessed using the risk of bias 2 tool.
RESULTS: A total of 24 trials incorporating 2107 patients were reviewed (aged 16-75 years; 51.2% male); 16 trials were included in the network meta-analysis. Adalimumab had significantly lower odds of endoscopic recurrence than did aminosalicylic acid (ASA) (odds ratio [OR], 0.08; 95% CI, 0.02-0.33), azathioprine (OR, 0.16; 95% CI, 0.05-0.54), probiotics (OR, 0.08; 95% CI, 0.012-0.52), or no treatment/placebo (OR, 0.068; 95% CI, 0.017-0.27) and was also associated with significantly lower odds of clinical recurrence than ASA (OR, 0.13; 95% CI, 0.036-0.46), azathioprine (OR, 0.24; 95% CI, 0.08-0.73), and no treatment/placebo (OR, 0.13; 95% CI, 0.035-0.5). Overall, adalimumab was the highest ranked with the lowest likelihood of endoscopic or clinical recurrence.
CONCLUSION: Compared with no treatment or placebo, only adalimumab and infliximab were associated with significantly lower odds of clinical and endoscopic recurrence. This systematic review found that adalimumab had the highest rank in prophylaxis against endoscopic and clinical recurrence of Crohn's disease after surgery; however, it was associated with a higher likelihood of developing severe adverse events.