Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul 03722, Republic of Korea.
Autoimmun Rev. 2019 May;18(5):439-454. doi: 10.1016/j.autrev.2019.03.002. Epub 2019 Mar 4.
Ulcerative colitis (UC) and Crohn's disease (CD) are the two major types of inflammatory bowel disease (IBD). We conducted a comprehensive review of meta-analyses to summarize the reported effectiveness of different drugs for IBD. We performed a literature search and a total of 110 meta-analyses from 66 articles were summarized and re-analyzed (62 in UC and 48 in CD). In summary, 5-ASA was more effective than placebo in both induction and maintenance treatment of UC, but there were conflicting results on the effect of 5-ASA on the induction treatment or relapse of CD. The use of immunomodulatory agents in the induction or maintenance phase of UC and CD using immunomodulators appeared to be more effective than placebo, but the results were impacted by small number of patients, discordant results with the largest study and risk of biases. Anti-TNF-α and anti-integrin therapeutic antibodies in both, induction and maintenance, showed a better efficacy than placebo in a large proportion of patients analyzed. Other agents, such as probiotics, antibiotics, omega-3, were shown to be more effective than placebo, but the same issues arose as stated above with the use of immunomodulatory agents. In conclusion, we performed a comprehensive review of meta-analysis on comparative efficacy of pharmacotherapy used in the management of IBD. Our review will augment our understanding of the treatment of UC and CD by providing a guideline for interpreting the statistically significant findings and discusses the optimal choice for IBD treatment.
溃疡性结肠炎（UC）和克罗恩病（CD）是两种主要的炎症性肠病（IBD）。我们对荟萃分析进行了全面综述，以总结不同药物治疗 IBD 的报告效果。我们进行了文献检索，共总结和重新分析了 66 篇文章中的 110 项荟萃分析（UC 中 62 项，CD 中 48 项）。总的来说，5-ASA 在 UC 的诱导和维持治疗中比安慰剂更有效，但 5-ASA 对 CD 的诱导治疗或复发的影响存在矛盾的结果。在 UC 和 CD 的诱导或维持阶段使用免疫调节剂似乎比安慰剂更有效，但结果受到患者数量少、与最大研究不一致和存在偏倚的风险的影响。在分析的大部分患者中，抗 TNF-α 和抗整合素治疗性抗体在诱导和维持治疗中比安慰剂更有效。其他药物，如益生菌、抗生素、ω-3，被证明比安慰剂更有效，但与免疫调节剂的使用一样，也出现了上述相同的问题。总之，我们对用于治疗 IBD 的药物治疗的比较疗效进行了全面的荟萃分析综述。我们的综述将通过提供解释统计学显著发现的指南来增强我们对 UC 和 CD 治疗的理解，并讨论 IBD 治疗的最佳选择。
