Vassiliki Sinopoulou, Morris Gordon, Shiyao Liu, Daniel Arruda Navarro Albuquerque, Aderonke Ajiboye, Sudheer Kumar Vuyyuru, Shellie Jane Radford, Gordon William Moran
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引用次数: 0
Abstract
Background: With the range of options available for the treatment of Crohn's disease, therapy selection can be challenging in clinical practice. Comparative efficacy data are needed to clarify the relative position of the increasingly complex portfolio of advanced therapies and guide decision-making.
Objectives: Our aim was to compare all advanced and immunomodulator treatments for efficacy and safety in maintenance of remission.
Design: Systematic review and network meta-analysis.
Data sources and methods: We searched databases up to June 2025. Our outcomes were clinical relapse, loss of response, endoscopic relapse, and safety outcomes. We estimated risk ratio (RR) and 95% confidence interval (CI). We used GRADE to assess certainty of results, and surface under the cumulative ranking curve for ranking treatments.
Results: A total of 37 randomised controlled trials with 7415 participants were included. Interventions ranged between 22 weeks and 2 years. Adalimumab probably prevents clinical relapse over placebo (RR 0.68, 95% CI 0.54-0.84, Number Needed to Treat (NNT) = 2, moderate effect magnitude). CT-P13 (RR 0.52, 95% CI 0.38-0.71) and infliximab (RR 0.61, 95% CI 0.49-0.76) may prevent clinical relapse. Upadacitinib is more effective than placebo at preventing loss of clinical response (RR 0.64, 95% CI 0.57-0.72, NNT = 2, small magnitude), while CT-P13 (RR 0.46, 95% CI 0.35-0.53, NNT = 1, large magnitude), natalizumab (RR 0.54, 95% CI 0.43-0.68, NNT = 2, moderate magnitude), certolizumab (RR 0.57, 95% CI 0.47-0.7), NNT = 2, moderate magnitude), adalimumab (RR 0.68, 95% CI 0.61-0.75, NNT = 2, small effect magnitude) and ustekinumab (RR 0.73, 95% CI 0.61-0.86, NNT = 2, small magnitude) probably prevent loss of clinical response. Infliximab (RR 0.7, 95% CI 0.59-0.82) and vedolizumab (RR 0.82, 95% CI 0.68-0.99) may prevent loss of clinical response. Endoscopic relapse could not be analysed. Safety evidence is uncertain, but treatments appear generally safe in the short term.
Conclusion: Adalimumab has moderate certainty for maintaining clinical remission with a moderate effect size. Novel therapies seem to have similar effect sizes, though imprecision due to limited evidence precludes further conclusions.
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.
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