Yang Seungwon, Yang Siyoung, Kwon Jo Young, Kim Seungyeon, Jung Chang Min, Choi Junjeong, Hee Cheon Jae, Yu Yun Mi
Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea.
College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
Ther Adv Chronic Dis. 2021 Sep 8;12:20406223211041927. doi: 10.1177/20406223211041927. eCollection 2021.
A large proportion of patients with inflammatory bowel disease (IBD) relapse after drug discontinuation despite achieving a stable state of infliximab-induced clinical remission. Resuming the use of the same tumor necrosis factor-alpha (TNF-α) inhibitors in patients who relapse following TNF-α inhibitor discontinuation was suggested as a treatment strategy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of infliximab retreatment in patients with IBD.
A systematic literature search to shortlist relevant studies was conducted using the MEDLINE, Embase, CINAHL, and SCOPUS databases for studies published from inception to August 2020.
Nine studies were included in the meta-analysis. The pooled clinical remission rate of infliximab retreatment in patients with IBD was 85% (95% confidence interval (CI), 81-89%) for induction treatment and 73% (95% CI, 66-80%) for maintenance treatment. A clinical remission rate following infliximab reintroduction was achieved in a greater proportion of patients with Crohn's disease (87%; 95% CI, 83-91%) than in those with ulcerative colitis (78%; 95% CI, 61-91%) for induction treatment, but the difference was not statistically significant. Infusion-related reactions after infliximab retreatment occurred in 9% of patients with IBD (95% CI, 3-16%).
Infliximab retreatment showed high clinical remission rates with tolerable infusion-related reactions in patients with IBD who achieved remission with initial infliximab treatment but relapsed after its discontinuation. We suggest infliximab as a viable alternative in patients with IBD who previously responded well to infliximab treatment.
尽管英夫利昔单抗诱导的临床缓解已达到稳定状态，但很大一部分炎症性肠病（IBD）患者在停药后仍会复发。有人建议将停用肿瘤坏死因子-α（TNF-α）抑制剂后复发的患者重新使用相同的TNF-α抑制剂作为一种治疗策略。我们进行了一项系统评价和荟萃分析，以评估英夫利昔单抗再治疗对IBD患者的疗效和安全性。
使用MEDLINE、Embase、CINAHL和SCOPUS数据库对从创刊至2020年8月发表的研究进行系统文献检索，以筛选出相关研究。
荟萃分析纳入了9项研究。IBD患者英夫利昔单抗再治疗的诱导治疗合并临床缓解率为85%（95%置信区间（CI），81-89%），维持治疗为73%（95%CI，66-80%）。诱导治疗中，克罗恩病患者（87%；95%CI，83-91%）达到英夫利昔单抗重新引入后的临床缓解率高于溃疡性结肠炎患者（78%；95%CI，61-91%），但差异无统计学意义。IBD患者英夫利昔单抗再治疗后9%出现输液相关反应（95%CI，3-16%）。
英夫利昔单抗再治疗在最初使用英夫利昔单抗治疗缓解但停药后复发的IBD患者中显示出高临床缓解率，且输液相关反应可耐受。我们建议将英夫利昔单抗作为先前对英夫利昔单抗治疗反应良好的IBD患者的一种可行选择。
