Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA.
Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Aliment Pharmacol Ther. 2017 Jan;45(1):3-13. doi: 10.1111/apt.13847. Epub 2016 Nov 10.
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.
To investigate the comparative efficacy of currently available inflammatory bowel disease (IBD) therapies to reduce hospitalisation and surgery.
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.
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.
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.
克罗恩病（CD）和溃疡性结肠炎（UC）具有进行性病程，导致住院和手术。现有治疗方法改变疾病进程的能力尚不清楚。
研究目前可用的炎症性肠病（IBD）治疗方法降低住院率和手术率的比较疗效。
我们在 MEDLINE/PubMed 中进行了系统评价，检索了 1980 年 1 月至 2016 年 5 月期间发表的关于生物制剂或免疫调节剂治疗 IBD 的随机对照试验（RCT）。我们对住院和手术的比例进行了直接比较。使用随机效应贝叶斯网络荟萃分析进行两两比较，以评估不同治疗方法的比较疗效。
我们确定了 7 项随机对照试验（5 项 CD；2 项 UC），比较了三种生物制剂和一种免疫调节剂与安慰剂的疗效。在 CD 中，抗 TNF 生物制剂与安慰剂相比，显著降低了住院率[比值比（OR）0.46，95%置信区间（CI）0.36-0.60]和手术率（OR 0.23，95%CI 0.13-0.42）。与硫唑嘌呤或 vedolizumab 相比，无统计学意义的降低。硫唑嘌呤在预防 CD 相关住院治疗方面劣于 infliximab 和 adalimumab（>97.5%的概率）。抗 TNF 生物制剂在 UC 中显著降低了住院率（OR 0.48，95%CI 0.29-0.80）和手术率（OR 0.67，95%CI 0.46-0.97）。在活性治疗之间的两两比较中，没有统计学意义的差异。
在 CD 和 UC 中，抗 TNF 生物制剂可有效降低住院率和手术率 50%和 33-77%。硫唑嘌呤和 vedolizumab 与类似的改善无关，但由于 RCT 数量有限，可能限制了可靠的结论。
