Lee, M.J. orcid.org/0000-0001-9971-1635, Parker, C.E., Taylor, S.R. et al. (4 more authors) (2018) Efficacy of medical therapies for fistulizing Crohn’s disease : systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 16 (12). pp. 1879-1892. ISSN 1542-3565
Abstract
Background & Aims
Fistulas are debilitating complications of Crohn’s disease (CD) that affect up to 50% of patients. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of treatments for fistulizing CD.
Methods
We searched publication databases from inception through December 13, 2016 for trials comparing the efficacy of a therapeutic agent (single or combination) with placebo or another active therapy in adult patients with any form of fistulizing CD. The Cochrane risk of bias tool was used to assess the methodological quality of trials; the overall quality of evidence was evaluated using GRADE. Primary outcomes included induction and maintenance of fistula response and remission. Pooled risk ratios (RRs) and 95% CIs were calculated for each outcome.
Results
We analyzed data from 27 trials; most studies (21/27) focused on patients with perianal fistulizing CD. We found moderate-quality evidence to support the efficacy of tumor necrosis factor (TNF) antagonists (RR, 2.01; 95% CI, 1.36–2.97), particularly infliximab, ustekinumab (RR, 1.77; 95% CI, 0.93–3.37), and mesenchymal stem cell therapy (RR, 1.31; 95% CI, 0.98–1.73) for induction of fistula remission. We found low-quality evidence for the efficacy of vedolizumab and immunosuppressives. There was also low-quality evidence to support the efficacy of combination therapy with TNF antagonists and antibiotics vs a TNF antagonist alone.
Conclusion
In a systematic review and meta-analysis of 27 controlled trials, we found TNF antagonists to be effective for induction and maintenance of perianal fistula response and remission. There are few data on the effects on internal fistulae. Further studies are needed, particularly for ustekinumab, vedolizumab, and stem cell therapies, in patients with fistulizing CD.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 by the AGA Institute. |
Keywords: | Drug; Healing; IBD; Immune suppression; Infection |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Academic Unit of Medical Education (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 22 Apr 2020 11:37 |
Last Modified: | 22 Apr 2020 11:39 |
Published Version: | https://www.cghjournal.org/article/S1542-3565(18)3... |
Status: | Published |
Publisher: | Elsevier (AGA Institute) |
Refereed: | Yes |
Identification Number: | 10.1016/j.cgh.2018.01.030 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:159748 |