Systematic review and network meta-analysis comparing the efficacy of conventional therapy and biologics to prevent endoscopic postoperative recurrence in patients with Crohn's disease.

IF 3.4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2025-09-30 eCollection Date: 2025-01-01 DOI:10.1177/17562848251374240

Marianne Hupé, Bruno Pereira, Anthony Buisson

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引用次数: 0

Abstract

Background: As no direct comparison is available between drugs to prevent endoscopic postoperative recurrence (POR) in Crohn's disease (CD), hierarchizing these therapeutic options remains challenging.

Objectives: We aimed to compare the effectiveness of treatments to prevent CD endoscopic POR.

Design: Systematic review and network meta-analysis using a random-effects model.

Data sources and methods: We include studies comparing treatments to prevent CD POR according to PRISMA guidelines. The primary endpoint was endoscopic POR (Rutgeerts score ⩾i2). Surface under the cumulative ranking (SUCRA) was used to hierarchize the treatments.

Results: Twenty studies were included (2414 patients). Overall heterogeneity was moderate (τ = 0.34). Ustekinumab (odds ratio (OR) = 0.23 (0.07-0.70); OR = 0.29 (0.08-0.99)), vedolizumab (OR = 0.17 (0.05-0.59); OR = 0.22 (0.06-0.85)), infliximab (OR = 0.18 (0.36-0.88); OR = 0.23 (0.09-0.54)), and adalimumab (OR = 0.17 (0.07-0.42); OR = 0.22 (0.08-0.59)) were more effective to prevent endoscopic POR than placebo or 5-ASA, respectively, contrary to thiopurines (OR = 0.52 (0.22-1.24); OR = 0.66 (0.25-1.76)). Adalimumab (OR = 0.33 (0.15-0.74)) and infliximab (OR = 0.34 (0.13-0.87)) were more effective than thiopurines. While no difference was observed between the four biologics, adalimumab (SUCRA = 0.81), infliximab (SUCRA = 0.80), vedolizumab (SUCRA = 0.79), and ustekinumab (SUCRA = 0.72) had the highest likelihood of being the most effective drug, contrary to thiopurines (SUCRA = 0.41), 5-ASA (SUCRA = 0.24), or placebo (SUCRA = 0.16).

Conclusion: This network meta-analysis confirms the efficacy of anti-TNF agents, vedolizumab, and ustekinumab in preventing endoscopic CD POR without any difference between them. When a prophylactic therapy is needed, biologics should be preferred to 5-ASA or thiopurines.

Trial registration: PROSPERO registration number CRD42024555528.

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比较常规治疗和生物制剂预防克罗恩病内镜术后复发的疗效的系统评价和网络荟萃分析。

背景：由于预防克罗恩病（CD）内镜下术后复发（POR）的药物之间没有直接的比较，因此对这些治疗方案进行分级仍然具有挑战性。目的：我们旨在比较预防CD内镜下POR的治疗方法的有效性。设计：采用随机效应模型进行系统评价和网络荟萃分析。数据来源和方法：我们纳入了根据PRISMA指南比较预防CD POR治疗的研究。主要终点是内镜下POR （Rutgeerts评分大于或等于2）。采用累积排序法（SUCRA）对各处理进行分级。结果：纳入20项研究（2414例患者）。总体异质性为中等（τ = 0.34）。Ustekinumab(优势比(OR) = 0.23 (0.07-0.70)；= 0.29 (0.08 - -0.99)), vedolizumab(或= 0.17 (0.05 - -0.59);= 0.22(0.06 - -0.85)),英夫利昔单抗(或= 0.18 (0.36 - -0.88);= 0.23 (0.09 - -0.54)), adalimumab(或= 0.17 (0.07 - -0.42);OR = 0.22(0.08-0.59))分别比安慰剂或5-ASA更有效地预防内镜下POR，与硫嘌呤相反(OR = 0.52 (0.22-1.24)；Or = 0.66(0.25-1.76))。阿达木单抗（OR = 0.33(0.15-0.74)）和英夫利昔单抗（OR = 0.34(0.13-0.87)）比硫嘌呤类药物更有效。虽然四种生物制剂之间没有差异，但阿达木单抗（SUCRA = 0.81）、英夫利昔单抗（SUCRA = 0.80）、维多单抗（SUCRA = 0.79）和乌斯特金单抗（SUCRA = 0.72）最有可能成为最有效的药物，与硫嘌呤（SUCRA = 0.41）、5-ASA （SUCRA = 0.24）或安慰剂（SUCRA = 0.16）相反。结论：该网络荟萃分析证实了抗tnf药物、vedolizumab和ustekinumab预防内镜下CD POR的疗效，两者之间没有差异。当需要预防性治疗时，生物制剂应优于5-ASA或硫嘌呤。试验注册：普洛斯彼罗注册号CRD42024555528。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.