Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Dig Liver Dis. 2018 Oct;50(10):1004-1011. doi: 10.1016/j.dld.2018.05.017. Epub 2018 May 30.
Long-term inflammatory complications of IPAA include Crohn's Disease (CD) or "CD-like" (CDL) condition. We performed a meta-analysis to evaluate the efficacy of anti-tumor necrosis factor (anti-TNF) with or without immunomodulator (IM) therapy in this group of patients.
Literature databases were searched from inception to October 4, 2017. Further searches using references from papers of interest were conducted and, abstracts from major GI conferences were searched. The primary endpoint was: complete clinical response in the two arms.
Out of 9 identified studies 4 were included for quantitative analysis. 48% (84/175) were female and mean age was 30.7 years. There was no significant difference in complete clinical response rates, RR 0.58 (95%CI 0.13-2.54, p = 0.5) or partial clinical response rates of RR 0.98 (95%CI 0.52-1.83, p = 0.94). All patients achieved endoscopic and deep remission in the only study reporting these outcomes comparatively in the two arms. There was a trend towards higher risk of major [RR 3.89, (95%C 0.92-16.45 p = 0.09)], and minor adverse events [RR 3.07 (95%CI 0.7-13.52 p = 0.28)] when using anti-TNF therapy compared to anti-TNF with IM.
We found no difference in outcomes with anti-TNF monotherapy compared to concurrent anti-TNF therapy with IM. Additional studies are needed to define the optimal therapy for CD after IPAA.
回肠贮袋肛管吻合术后的长期炎症并发症包括克罗恩病（CD）或“类似 CD”（CDL）。我们进行了一项荟萃分析，以评估在这组患者中使用抗肿瘤坏死因子（anti-TNF）联合或不联合免疫调节剂（IM）治疗的疗效。
从研究开始到 2017 年 10 月 4 日，我们搜索了文献数据库。还通过对相关论文的参考文献进行进一步搜索，并对主要胃肠会议的摘要进行了搜索。主要终点是：两组的完全临床缓解。
在确定的 9 项研究中，有 4 项进行了定量分析。女性占 48%（84/175），平均年龄为 30.7 岁。完全临床缓解率、RR0.58（95%CI0.13-2.54，p=0.5）或部分临床缓解率 RR0.98（95%CI0.52-1.83，p=0.94）无显著差异。在仅比较两组比较这两种结果的唯一一项研究中，所有患者均达到内镜和深度缓解。与使用抗 TNF 治疗相比，使用抗 TNF 治疗时，发生主要不良事件的风险[RR3.89，（95%C0.92-16.45，p=0.09)]和次要不良事件[RR3.07（95%CI0.7-13.52，p=0.28)]的风险更高，但趋势不明显。
我们发现与抗 TNF 单药治疗相比，抗 TNF 联合 IM 治疗的疗效无差异。需要进一步的研究来确定 IPAA 后 CD 的最佳治疗方法。
