Division of Gastroenterology and Hepatology, American University of Beirut, Beirut, Lebanon.
Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, Brazil.
Inflamm Bowel Dis. 2024 Mar 1;30(3):459-469. doi: 10.1093/ibd/izad033.
Despite the growing therapeutic armamentarium, at least half of the patients with Crohn's disease will require surgery during their lifetime. Current evidence for the prevention and treatment of postoperative Crohn's disease supports the use of anti-tumor necrosis factor agents with limited data about the use of the newer biologics, vedolizumab and ustekinumab.
We performed a systematic review of available data to determine the efficacy of the newer biologics in the management of postoperative Crohn's disease. We included noncomparative and comparative studies. The main outcomes of interest were clinical and endoscopic postoperative recurrence rates.
The search strategy identified 1231 citations, with 32 eligible for review. Several studies showed that the postoperative Crohn's disease recurrence rates with the use of the newer biologics were comparable to previously published results with the use of anti-tumor necrosis factor agents, while other studies failed to show their efficacy. It is important to note that the studies were heterogeneous and included a relatively small sample size, making it difficult to draw a definite conclusion about the efficacy of the newer biologics in the management of postoperative Crohn's disease.
The newer biologics do play a role in the management of postoperative Crohn's disease. After our review, we proposed an updated algorithm on the role of newer biologics in the approach to patients with postoperative Crohn's disease. Yet, until we have better-designed studies, their definite positioning remains to be determined.
尽管治疗方法不断增加，但至少有一半的克罗恩病患者在其一生中需要手术。目前，预防和治疗术后克罗恩病的证据支持使用抗肿瘤坏死因子药物，但关于新型生物制剂，如维多珠单抗和乌司奴单抗的使用，数据有限。
我们对现有数据进行了系统评价，以确定新型生物制剂在治疗术后克罗恩病中的疗效。我们纳入了非对照和对照研究。主要观察指标是术后临床和内镜复发率。
搜索策略确定了 1231 条引文，其中 32 条符合审查标准。一些研究表明，新型生物制剂治疗术后克罗恩病的复发率与先前发表的使用抗肿瘤坏死因子药物的结果相当，而其他研究未能显示其疗效。需要注意的是，这些研究存在异质性，且样本量相对较小，因此难以对新型生物制剂在治疗术后克罗恩病中的疗效得出明确结论。
新型生物制剂在治疗术后克罗恩病中确实发挥了作用。经过我们的审查，我们提出了一个更新的关于新型生物制剂在术后克罗恩病患者治疗中的作用的算法。然而，在我们有更好设计的研究之前，它们的明确定位仍有待确定。
