Network meta-analysis: efficacy and safety of treatments for fistulising Crohn's disease.
Journal
European journal of gastroenterology & hepatology
ISSN: 1473-5687
Titre abrégé: Eur J Gastroenterol Hepatol
Pays: England
ID NLM: 9000874
Informations de publication
Date de publication:
01 07 2023
01 07 2023
Historique:
medline:
6
6
2023
pubmed:
28
4
2023
entrez:
28
4
2023
Statut:
ppublish
Résumé
Fistulas are a debilitating complication of Crohn's disease and treatment options remain limited. There is a lack of head-to-head comparisons between treatments. To our knowledge, this is the first network meta-analysis on the efficacy of medical therapies in achieving fistula remission and maintenance of fistula closure in Crohn's disease. Biomedical databases and the Cochrane Central Registry were searched between 1978 and 2022 for randomized controlled trials (RCTs) reporting on treatments. A network meta-analysis was performed using the frequentist model with pooled relative risks (RRs) and P -scores used to rank treatments. Twenty-five RCTs were included for analysis with 2239 patients included. At the 16-24 week time point, infliximab produced the only statistically significant result with the 5 mg/kg dose proving the most effective [RR, 2.30; 95% confidence interval (CI), 1.40-3.77]. At 44 weeks, ustekinumab was found to be most superior with it being 2.38 times (RR, 2.38; 95% CI, 1.24-4.56) more superior to placebo, with adalimumab (RR, 2.06; 95% CI, 1.06-3.99) and infliximab 5 mg/kg (RR, 1.68; 95% CI, 1.03-2.75) also producing a statistically significant result. Despite infliximab being favoured in international guidelines for the treatment of perianal fistulising Crohn's disease, biologics such as ustekinumab, vedolizumab and adalimumab show promising results.
Identifiants
pubmed: 37115969
doi: 10.1097/MEG.0000000000002552
pii: 00042737-202307000-00002
doi:
Substances chimiques
Adalimumab
FYS6T7F842
Antibodies, Monoclonal
0
Immunosuppressive Agents
0
Infliximab
B72HH48FLU
Ustekinumab
FU77B4U5Z0
Types de publication
Meta-Analysis
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
702-710Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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