Anti-TNFα agents are the best choice in preventing postoperative Crohn's disease: A meta-analysis

Adrienn Erős; Nelli Farkas; Péter Hegyi; Anikó Szabó; Márta Balaskó; Gábor Veres; László Czakó; Judit Bajor; Hussain Alizadeh; Zoltán Rakonczay; Alexandra Mikó; Tamás Habon; Bálint Erőss; Bálint Bérczi; Patricia Sarlós

doi:10.1016/j.dld.2019.05.027

Anti-TNFα agents are the best choice in preventing postoperative Crohn's disease: A meta-analysis

Dig Liver Dis. 2019 Aug;51(8):1086-1095. doi: 10.1016/j.dld.2019.05.027. Epub 2019 Jul 3.

Authors

Affiliations

¹ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Paediatrics, University of Debrecen, Debrecen, Hungary; Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
² Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary; Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
³ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Szentágothai Research Centre, University of Pécs, Pécs, Hungary; Hungarian Academy of Sciences, University of Szeged Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁴ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁵ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Paediatrics, University of Debrecen, Debrecen, Hungary.
⁶ First Department of Medicine, University of Szeged, Szeged, Hungary.
⁷ First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁸ Hungarian Academy of Sciences, University of Szeged Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary; First Department of Medicine, University of Szeged, Szeged, Hungary.
⁹ Szentágothai Research Centre, University of Pécs, Pécs, Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
¹⁰ Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary.
¹¹ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Szentágothai Research Centre, University of Pécs, Pécs, Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary. Electronic address: [email protected].

PMID: 31278016
DOI: 10.1016/j.dld.2019.05.027

Abstract

Background: Despite the high rate of postoperative recurrence (POR) in Crohn's disease (CD), there is no widely accepted consensus on its prevention.

Aim: To compare the efficacy of biological and conventional therapies in preventing POR of CD.

Methods: We searched four electronic databases up to April 2019 for articles that examined the efficacy of different preventive therapies against POR. Our PICO was: (P) adults with CD who underwent intestinal resection, (I) biological agents, (C) conventional therapies or a placebo, and (O) clinical, endoscopic, and histological POR.

Results: Anti-TNFα agents were significantly better in preventing clinical, endoscopic, severe endoscopic and histological POR compared to conventional therapies (OR: 0.508, 95% CI: 0.309-0.834, P = 0.007; OR: 0.312, 95% CI: 0.199-0.380, P < 0.001; OR: 0.195, 95% CI: 0.107-0.356, P < 0.001; and OR: 0.255, 95% CI: 0.106-0.611, P = 0.002, respectively), as well as in the subgroup of nonselected CD patients (OR: 0.324, 95% CI: 0.158-0.664, P = 0.002; OR: 0.225, 95% CI: 0.124-0.409, P < 0.001; and OR: 0.248, 95% CI: 0.070-0.877, P = 0.031, respectively). Infliximab and adalimumab proved to be equally effective in preventing endoscopic POR.

Conclusion: Anti-TNFα agents are more effective in preventing clinical, endoscopic and histological POR than conventional therapies, even in nonselected CD patients.

Keywords: Adalimumab; Anti-TNFα; Crohn’s disease; Infliximab; Postoperative recurrence; Preventive treatment.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adalimumab
Crohn Disease / prevention & control*
Crohn Disease / surgery*
Gastrointestinal Agents / therapeutic use*
Humans
Infliximab
Postoperative Period
Preoperative Period
Recurrence
Secondary Prevention
Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

Gastrointestinal Agents
Tumor Necrosis Factor-alpha
Infliximab
Adalimumab