Systematic review with meta‐analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis

Summary Introduction Crohn's disease (CD) and ulcerative colitis (UC) have a progressive course leading to hospitalisation and surgery. The ability of existing therapies to alter disease course is not clearly defined. Aim To investigate the comparative efficacy of currently available inflammato...

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Bibliographic Details
Published in:Alimentary pharmacology & therapeutics 2017-01, Vol.45 (1), p.3-13
Main Authors: Mao, E. J., Hazlewood, G. S., Kaplan, G. G., Peyrin‐Biroulet, L., Ananthakrishnan, A. N.
Format: Article
Language:English
Subjects:
Azathioprine
Bayesian analysis
Biological Products - therapeutic use
Colitis, Ulcerative - diagnosis
Colitis, Ulcerative - drug therapy
Colitis, Ulcerative - surgery
Colon
Crohn Disease - diagnosis
Crohn Disease - drug therapy
Crohn Disease - surgery
Crohn's disease
Crohns disease
Hospitalization - trends
Humans
Immunosuppressive agents
Immunosuppressive Agents - therapeutic use
Inflammatory bowel disease
Inflammatory bowel diseases
Infliximab
Intestine
Meta-analysis
Monoclonal antibodies
Randomization
Randomized Controlled Trials as Topic - methods
Statistical analysis
Surgery
Treatment Outcome
Tumor necrosis factor-α
Ulcerative colitis
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Summary:Summary Introduction Crohn's disease (CD) and ulcerative colitis (UC) have a progressive course leading to hospitalisation and surgery. The ability of existing therapies to alter disease course is not clearly defined. Aim To investigate the comparative efficacy of currently available inflammatory bowel disease (IBD) therapies to reduce hospitalisation and surgery. Methods We conducted a systematic review in MEDLINE/PubMed for randomised controlled trials (RCT) published between January 1980 and May 2016 examining efficacy of biological or immunomodulator therapy in IBD. We performed direct comparisons of pooled proportions of hospitalisation and surgery. Pair‐wise comparisons using a random‐effects Bayesian network meta‐analysis were performed to assess comparative efficacy of different treatments. Results We identified seven randomised controlled trials (5 CD; 2 UC) comparing three biologics and one immunomodulator with placebo. In CD, anti‐TNF biologics significantly reduced hospitalisation [Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.36–0.60] and surgery (OR 0.23, 95% CI 0.13–0.42) compared to placebo. No statistically significant reduction was noted with azathioprine or vedolizumab. Azathioprine was inferior to both infliximab and adalimumab in preventing CD‐related hospitalisation (>97.5% probability). Anti‐TNF biologics significantly reduced hospitalisation (OR 0.48, 95% CI 0.29–0.80) and surgery (OR 0.67, 95% CI 0.46–0.97) in UC. There were no statistically significant differences in the pair‐wise comparisons between active treatments. Conclusions In CD and UC, anti‐TNF biologics are efficacious in reducing the odds of hospitalisation by half and surgery by 33–77%. Azathioprine and vedolizumab were not associated with a similar improvement, but robust conclusions may be limited due to paucity of RCTs.
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.13847