Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology, Ministry of Health, Inflammatory Bowel Disease Research Center, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Dig Dis. 2019 Feb;20(2):65-72. doi: 10.1111/1751-2980.12698.
To determine the potential predictors of loss of response (LOR) to infliximab (IFX) maintenance therapy for adult patients with Crohn's disease (CD).
We searched for English-language articles published between 1990 and March 2017 in PubMed, Embase, and the Cochrane Library. After identifying eligible studies, data extraction was performed independently by two reviewers. The potential prognostic variables were identified and dichotomized for meta-analysis. Based on the heterogeneity among study variables, random-effects models was used in our meta-analysis.
Twenty-six studies met our eligibility criteria and consolidated drug response data were obtained from 3212 patients. The pooled rate of LOR to IFX maintenance therapy with a median follow-up of 1.1 years was 34%. The incidence of LOR to IFX therapy was increased in CD patients with perianal lesions (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.04-2.75, P = 0.03), colon involvement (OR 2.56, 95% CI 1.20-5.50, P = 0.02) and younger age at CD onset (standardized mean difference -0.79, 95% CI -1.41 to -0.18, P = 0.01).
The meta-analysis estimates the incidence of LOR among adult CD patients undergoing IFX therapy is 34%. The presence of perianal lesions, younger age at CD onset, and involvement of the colon are relative risk factors of LOR in CD patients received scheduled IFX maintenance therapy.
确定影响克罗恩病（CD）成年患者对英夫利昔单抗（IFX）维持治疗应答丧失（LOR）的潜在预测因素。
我们检索了 1990 年至 2017 年 3 月期间在 PubMed、Embase 和 Cochrane 图书馆发表的英文文章。在确定合格的研究后，由两名评审员独立进行数据提取。确定了潜在的预后变量，并对其进行了二分类以进行荟萃分析。根据研究变量之间的异质性，我们的荟萃分析采用了随机效应模型。
26 项研究符合纳入标准，从 3212 名患者中获得了合并的药物反应数据。在中位随访 1.1 年时，IFX 维持治疗 LOR 的汇总率为 34%。CD 患者伴有肛周病变（比值比 [OR] 1.69，95%置信区间 [CI] 1.04-2.75，P = 0.03）、结肠受累（OR 2.56，95% CI 1.20-5.50，P = 0.02）和 CD 发病年龄较小（标准化均数差 -0.79，95% CI -1.41 至 -0.18，P = 0.01）的患者，IFX 治疗 LOR 的发生率增加。
荟萃分析估计接受 IFX 治疗的 CD 成年患者 LOR 的发生率为 34%。肛周病变、CD 发病年龄较小和结肠受累是 CD 患者接受计划 IFX 维持治疗时 LOR 的相对危险因素。
