University of Kansas Medical Center, Internal Medicine Department, Division of Gastroenterology and Hepatology, Kansas City, Kansas, USA.
University of Toledo Medical Center, Department of Internal Medicine, Toledo, Ohio, USA.
Inflamm Bowel Dis. 2020 Nov 19;26(12):1808-1818. doi: 10.1093/ibd/izaa031.
While anti-tumor necrosis factor alpha (anti-TNFa) therapies for Crohn disease (CD) were initially introduced in 1998 for biologic therapies are often introduced after a minimum of 6 years after diagnosis. The benefit of anti-TNFa early in the course of CD is still controversial, with some studies showing better outcomes but others not. To determine whether earlier introduction of anti-TNFa therapy improves efficacy in clinical trials or clinical series, we aimed to perform a meta-analysis comparing early vs late anti-TNFa use in the management of CD.
A comprehensive search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to November 3, 2019. We included comparative studies of early vs late use of anti-TNFa therapy in adult patients with CD.
Eleven studies were included in the analysis, with a total of 2501 patients. Meta-analysis demonstrated that the early use of anti-TNFa was associated with a statistically significant decrease in the need for surgery (relative risk [RR] = 0.43; 95% confidence interval [CI], 0.26-0.69; I2 = 68%) and disease progression (RR = 0.51; 95% CI, 0.35-0.75; I2 = 61%). Early use also showed an increase in early remission (RR = 1.94; 95% CI, 1.54-2.46; I2 = 0%) and clinical response. There was no statistically significant difference in achieving late remission (RR = 1.39; 95% CI, 0.94-2.05; I2 = 65%) or mucosal healing (RR = 1.10; 95% CI, 0.63-1.91; I2 = 0%).
This systematic review suggests that using anti-TNFa earlier in the treatment of CD (within 3 years) may improve clinical outcomes compared to late administration in terms of achieving early clinical remission, clinical response, disease progression, and the need for surgery.
虽然抗肿瘤坏死因子 α（anti-TNFa）疗法于 1998 年首次被引入用于治疗克罗恩病（CD），但生物疗法通常在诊断后至少 6 年后才引入。在 CD 病程早期使用 anti-TNFa 的益处仍存在争议，一些研究表明效果更好，但也有其他研究未得出该结论。为了确定在临床试验或临床系列中更早引入 anti-TNFa 治疗是否能提高疗效，我们旨在进行一项荟萃分析，比较 CD 管理中早期与晚期使用 anti-TNFa 的疗效。
从每个数据库的创建到 2019 年 11 月 3 日，对 MEDLINE、EMBASE、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和 Scopus 进行了全面检索。我们纳入了比较成人 CD 患者早期与晚期使用 anti-TNFa 治疗的对照研究。
共有 11 项研究纳入分析，总共有 2501 名患者。荟萃分析表明，早期使用 anti-TNFa 与手术需求减少（相对风险 [RR] = 0.43；95%置信区间 [CI]，0.26-0.69；I² = 68%）和疾病进展（RR = 0.51；95% CI，0.35-0.75；I² = 61%）显著相关。早期使用还显示早期缓解（RR = 1.94；95% CI，1.54-2.46；I² = 0%）和临床反应的增加。在实现晚期缓解（RR = 1.39；95% CI，0.94-2.05；I² = 65%）或黏膜愈合（RR = 1.10；95% CI，0.63-1.91；I² = 0%）方面，差异无统计学意义。
这项系统评价表明，与晚期给药相比，在 CD 治疗的早期（3 年内）更早使用 anti-TNFa 可能会改善临床结局，表现在早期临床缓解、临床反应、疾病进展和手术需求方面。
