Efficacy of early biologic therapy versus late/conventional therapy in children and adolescents with Crohn's disease: A systematic review and meta-analysis.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2023-09-01 Epub Date: 2023-09-15 DOI:10.4103/sjg.sjg_190_23
Lei Zhang, Zhixiao Jin, Jia Hao
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引用次数: 0

Abstract

Background: The objective of this study was to estimate the effectiveness of early biologics compared to conventional treatment in the management of Crohn's disease among pediatric and adolescent patients.

Methods: A comprehensive literature search was conducted in four electronic databases to identify relevant studies published from inception to 2023. The inclusion criteria comprised randomized controlled trials (RCTs) and cohort studies that reported on the efficacy and clinical outcomes of early biologic therapy compared to late/conventional therapy in children with Crohn's disease. The quality of the studies was assessed using the Cochrane Risk of Bias tool and the Newcastle Ottawa scale.

Results: A total of 13 studies (2 RCTs and 11 cohort studies), involving 861 patients, were included in the meta-analysis. The results demonstrated that early biologic therapy was associated with a significantly higher rate of clinical remission (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.10-1.54), lower relapse rates (RR 0.33, 95% CI 0.21-0.53), and improved mucosal healing (RR 1.47, 95% CI 1.10-1.97) compared to late/conventional therapy. However, it should be noted that there was evidence of publication bias among studies reporting clinical remission.

Conclusion: In conclusion, early biologic therapy is significantly more effective in achieving clinical remission (within two years of diagnosis), promoting mucosal healing, and reducing relapse rates in pediatric and adolescent patients with Crohn's disease, compared to late/conventional therapy. These findings emphasize the importance of initiating biological therapy early in the treatment of Crohn's disease in this patient population.

儿童和青少年克罗恩病早期生物治疗与晚期/常规治疗的疗效:一项系统综述和荟萃分析。
背景:本研究的目的是评估早期生物制剂与传统治疗相比在儿童和青少年患者中治疗克罗恩病的有效性。方法:在四个电子数据库中进行全面的文献检索,以确定从开始到2023年发表的相关研究。纳入标准包括随机对照试验(RCT)和队列研究,这些研究报告了克罗恩病儿童早期生物治疗与晚期/常规治疗的疗效和临床结果。使用Cochrane偏倚风险工具和Newcastle Ottawa量表评估研究质量。结果:共有13项研究(2项随机对照试验和11项队列研究)纳入荟萃分析,涉及861名患者。结果表明,与晚期/常规治疗相比,早期生物治疗具有显著更高的临床缓解率(风险比[RR]1.30,95%置信区间[CI]1.10-1.54)、更低的复发率(RR 0.33,95%CI 0.21-0.53)和改善粘膜愈合(RR 1.47,95%CI 1.10-1.97)。然而,应该注意的是,有证据表明,在报告临床缓解的研究中存在发表偏倚。结论:总之,与晚期/常规治疗相比,早期生物治疗在实现儿童和青少年克罗恩病患者的临床缓解(诊断后两年内)、促进粘膜愈合和降低复发率方面明显更有效。这些发现强调了在该患者群体中尽早开始生物治疗克罗恩病的重要性。
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
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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