Coward Stephanie, Kuenzig M Ellen, Hazlewood Glen, Clement Fiona, McBrien Kerry, Holmes Rebecca, Panaccione Remo, Ghosh Subrata, Seow Cynthia H, Rezaie Ali, Kaplan Gilaad G
Departments of *Medicine and Community Health Sciences, †Community Health Sciences, and ‡Medicine, University of Calgary, Calgary, Alberta, Canada; and §Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Inflamm Bowel Dis. 2017 Mar;23(3):461-472. doi: 10.1097/MIB.0000000000001023.
Induction treatment of mild-to-moderate Crohn's disease is controversial.
To compare the induction of remission between different doses of mesalamine, sulfasalazine, corticosteroids, and budesonide for active Crohn's disease.
We identified randomized controlled trials from existing Cochrane reviews and an updated literature search in Medline, EMBASE, and CENTRAL to November 2015.
We included randomized controlled trials (n = 22) in adult patients with Crohn's disease that compared budesonide, sulfasalazine, mesalamine, or corticosteroids with placebo or each other, for the induction of remission (8-17 wks). Mesalamine (above and below 2.4 g/d) and budesonide (above and below 6 mg/d) were stratified into low and high doses.
Our primary outcome was remission, defined as a Crohn's Disease Activity Index score <150. A Bayesian random-effects network meta-analysis was performed on the proportion in remission.
Corticosteroids (odds ratio [OR] = 3.80; 95% credible interval [CrI]: 2.48-5.66), high-dose budesonide (OR = 2.96; 95% CrI: 2.06-4.30), and high-dose mesalamine (OR = 2.29; 95% CrI: 1.58-3.33) were superior to placebo. Corticosteroids were similar to high-dose budesonide (OR = 1.21; 95% CrI: 0.84-1.76), but more effective than high-dose mesalamine (OR = 1.83; 95% CrI: 1.16-2.88). Sulfasalazine was not significantly superior to any therapy including placebo.
Randomized controlled trials that use a strict definition of induction of remission and disease severity at enrollment to assess effectiveness in treating mild-to-moderate Crohn's disease are limited.
Corticosteroids and high-dose budesonide were effective treatments for inducing remission in mild-to-moderate Crohn's disease. High-dose mesalamine is an option among patients preferring to avoid steroids.
轻至中度克罗恩病的诱导治疗存在争议。
比较不同剂量的美沙拉嗪、柳氮磺胺吡啶、皮质类固醇和布地奈德对活动性克罗恩病的缓解诱导作用。
我们从现有的Cochrane系统评价以及截至2015年11月在Medline、EMBASE和CENTRAL数据库进行的更新文献检索中识别出随机对照试验。
我们纳入了针对成年克罗恩病患者的随机对照试验（n = 22），这些试验比较了布地奈德、柳氮磺胺吡啶、美沙拉嗪或皮质类固醇与安慰剂或相互之间在诱导缓解（8 - 17周）方面的效果。美沙拉嗪（每日2.4 g以上和以下）和布地奈德（每日6 mg以上和以下）被分为低剂量和高剂量。
我们的主要结局是缓解，定义为克罗恩病活动指数评分<150。对缓解比例进行了贝叶斯随机效应网络荟萃分析。
皮质类固醇（优势比[OR]=3.80；95%可信区间[CrI]：2.48 - 5.66）、高剂量布地奈德（OR = 2.96；95% CrI：2.06 - 4.30）和高剂量美沙拉嗪（OR = 2.29；95% CrI：1.58 - 3.33）优于安慰剂。皮质类固醇与高剂量布地奈德相似（OR = 1.21；95% CrI：0.84 - 1.76），但比高剂量美沙拉嗪更有效（OR = 1.83；95% CrI：1.16 - 2.88）。柳氮磺胺吡啶并不显著优于包括安慰剂在内的任何治疗方法。
使用严格的缓解诱导定义和入组时疾病严重程度来评估治疗轻至中度克罗恩病有效性的随机对照试验有限。
皮质类固醇和高剂量布地奈德是诱导轻至中度克罗恩病缓解的有效治疗方法。高剂量美沙拉嗪是不愿使用类固醇的患者的一种选择。
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