新型生物制剂、抗肿瘤坏死因子药物和免疫调节剂预防克罗恩病术后复发的疗效比较：一项系统评价和网状Meta分析
Comparative Efficacy of Novel Biologics, Anti-tumor Necrosis Factor Agents, and Immunomodulators to Prevent Postoperative Recurrence in Crohn's Disease: A Systematic Review and Network Meta-analysis.
作者信息
Duan Shihao, Chen Pingrun, Liang Chang, Zhang Yan
机构信息
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
J Crohns Colitis. 2025 Feb 4;19(2). doi: 10.1093/ecco-jcc/jjae143.
BACKGROUND AND AIMS
Our objective was to compare the efficacy of novel biologics (such as vedolizumab and ustekinumab), anti-tumor necrosis factor (anti-TNF) agents, and immunomodulators (IMMs) in preventing postoperative recurrence (POR) of Crohn's disease (CD).
METHODS
We searched the PubMed, Embase, and the Cochrane Library databases up to December 2023 to identify placebo-controlled, no-treatment comparison, or positive-controlled studies for the prevention of POR in CD. Endoscopic recurrence and clinical recurrence were the primary and secondary endpoints for the efficacy assessment. We conducted traditional direct and Bayesian network meta-analyses to evaluate the preventive effects of selected drugs. Additionally, we ranked interventions based on their scores under the Surface Under the Cumulative Ranking curve (SUCRA).
RESULTS
A total of 17 studies involving 2786 patients were included. In the direct meta-analysis, anti-TNFs, vedolizumab, and IMMs showed greater efficacy in preventing endoscopic POR, compared with controls (placebo or no treatment). In preventing clinical POR, anti-TNFs and IMMs outperformed the controls. The network meta-analysis revealed that the risk of endoscopic POR was considerably lower in patients receiving anti-TNFs, vedolizumab, and ustekinumab compared with controls. Regarding the reduction of clinical POR, only anti-TNFs showed significant efficacy compared with controls. Vedolizumab and anti-TNFs were ranked as the most effective strategies in preventing endoscopic and clinical recurrence, respectively.
CONCLUSIONS
According to direct and network meta-analysis, in CD patients after surgical resection, novel biologics, especially vedolizumab, were quite effective in decreasing the risk of endoscopic POR, whereas anti-TNFs appeared to perform best in reducing the risk of clinical POR.
背景与目的
我们的目标是比较新型生物制剂（如维多珠单抗和优特克单抗）、抗肿瘤坏死因子（抗TNF）药物以及免疫调节剂（IMM）在预防克罗恩病（CD）术后复发（POR）方面的疗效。
方法
我们检索了截至2023年12月的PubMed、Embase和Cochrane图书馆数据库，以确定用于预防CD患者POR的安慰剂对照、无治疗对照或阳性对照研究。内镜复发和临床复发是疗效评估的主要和次要终点。我们进行了传统的直接和贝叶斯网络荟萃分析，以评估所选药物的预防效果。此外，我们根据累积排序曲线下面积（SUCRA）得分对干预措施进行排序。
结果
共纳入17项研究，涉及2786例患者。在直接荟萃分析中，与对照组（安慰剂或无治疗）相比，抗TNF药物、维多珠单抗和IMM在预防内镜下POR方面显示出更高的疗效。在预防临床POR方面，抗TNF药物和IMM的表现优于对照组。网络荟萃分析显示，与对照组相比，接受抗TNF药物、维多珠单抗和优特克单抗治疗的患者内镜下POR风险显著降低。关于临床POR的降低，与对照组相比，只有抗TNF药物显示出显著疗效。维多珠单抗和抗TNF药物分别被列为预防内镜和临床复发的最有效策略。
结论
根据直接和网络荟萃分析，在手术切除后的CD患者中，新型生物制剂，尤其是维多珠单抗，在降低内镜下POR风险方面非常有效，而抗TNF药物在降低临床POR风险方面似乎表现最佳。
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