Comparative Efficacy of Anti-TNF Therapies For The Prevention of Postoperative Recurrence of Crohn’s Disease

Bakouny, Ziad; Yared, Fares; Rassy, Elie El; Jabbour, Rita; Hallit, Rabih; Khoury, Nathalie; Honein, Khalil; Jaoude, Joseph Bou

doi:10.1097/mcg.0000000000001006

Cited by 18 publications

(21 citation statements)

References 34 publications

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“…Moreover, patients undergoing anti‐TNF therapy after surgery did not have more AEs than patients who did not undergo surgery 18 . Similar to a previous meta‐analysis, this study showed that anti‐TNF therapy may safely contribute to preventing recurrence and disease development 2–5 . The most important outcomes are the long‐term avoidance of repeated surgery for recurrent lesions and maintaining the patient's quality of life (QOL).…”

Section: Discussionsupporting

confidence: 81%

“…Anti‐tumor necrosis factor (TNF) α agents are now well‐known effective treatments that result in both the induction of remission and the maintenance of remission in patients with CD. Several meta‐analyses have reported the efficacy of anti‐TNF therapy for preventing recurrence after surgery; however, the quality of its efficacy reported in some prospective studies differed according to the outcomes, which include clinical recurrence, endoscopic recurrence, and the reoperation rate for recurrent lesions 2–5 . Moreover, adverse events (AEs) associated with anti‐TNF therapy have not been extensively evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Does anti‐tumor necrosis factor alpha prevent the recurrence of Crohn's disease? Systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Anti-tumor necrosis factor (TNF) α agents are now well known to function as effective treatments for Crohn's disease (CD). Several meta-analyses have revealed the efficacy of anti-TNF therapy for preventing recurrence after surgery; however, the efficacies reported in some prospective studies differed according to the outcomes. Moreover, adverse events (AEs) were not well evaluated. We conducted this systematic review and meta-analysis to evaluate both the efficacy of anti-TNF therapy after stratification by the outcome of interest and the AEs. Methods: We performed a systematic literature review of studies investigating anti-TNF therapy, CD, and postoperative recurrence. Meta-analyses were performed for endoscopic and clinical recurrence and AEs. Results: A total of 570 participants, including 254 patients in the intervention group and 316 patients in the control group, in eight studies, were analyzed for recurrence. Based on the results of the meta-analysis, the efficacies of anti-TNF therapy at preventing endoscopic and clinical recurrence were as follows: relative risk (RR) 0.34, 95% confidence interval (CI) 0.22-0.53 and RR 0.60, 95% CI 0.36-1.02, respectively. The RR of AEs with anti-TNF therapy was 1.75 (95% CI 0.81-3.79). Conclusions: Anti-TNF therapy after surgery for CD displays efficacy at preventing endoscopic recurrence for 1-2 years, without increasing the incidence of AEs. However, clinical recurrence was not significantly reduced. The efficacy of postoperative anti-TNF therapy may differ in terms of the outcomes, which include long-term prevention, the avoidance of further surgery, and cost-effectiveness.Financial support This publication was supported by the Japanese Society of Gastroenterology.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Does anti‐tumor necrosis factor alpha prevent the recurrence of Crohn's disease? Systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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“…40 Two network meta-analyses suggested that there was no evidence of clinical superiority among anti-TNF agents. 41,42 The influence of obesity on different dose regimens was unknown. To address the influence of obesity on different dose regimens, we did a subgroup analysis of both fixed-dose and weight-based dose anti-TNF agents.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Obesity and the Effectiveness of Anti–Tumor Necrosis Factor-α Agents in Inflammatory Bowel Disease Patients: A Literature Review and Meta-analysis

Dai

Ran

2020

Ann Pharmacother

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Background: A total of 15% to 40% of adult inflammatory bowel disease (IBD) patients are obese. The influence of obesity on anti-tumor necrosis factor-α (anti-TNF-α) treatment in IBD patients is not consistent. Objective: To determine the association between obesity and the efficacy of anti-TNF treatment in IBD patients. Methods: We performed a systematic search from January 1990 through November 2019 on MEDLINE, Web of Science, Google Scholar, ClinicalTrials.gov, and Cochrane library. We included randomized controlled trials and observational cohort studies that investigated the outcome of anti-TNF treatment in IBD patients with stratification according to body mass index or body weight. The odds ratio (OR) and its 95% CI were calculated. Results: In this pooled meta-analysis, we observed that obesity increased the odds of failure of anti-TNF therapy (OR = 1.195; 95% CI = 1.034-1.380; P = 0.015; I2 = 47.8%). After performing subgroup analyses, obesity was associated with higher odds of anti-TNF treatment failure in ulcerative colitis (UC) patients (OR = 1.413; 95% CI = 1.008-1.980; P = 0.045; I2 = 20.0%) but not in Crohn’s disease patients (OR = 1.099; 95% CI = 0.928-1.300). Obesity significantly increased the odds of treatment failure of both dose-fixed and weight-based anti-TNF agents (OR = 1.121, 95% CI = 1.027-1.224, P = 0.011, and OR = 1.449, 95% CI = 1.006-2.087, P = 0.046, respectively). Conclusion and Relevance: In our meta-analysis, obesity was associated with the inferior response of anti-TNF treatments in UC patients. Clinicians should be aware that obese UC patients may require higher doses in anti-TNF treatment.

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“…Whereas proctocolectomy is considered curative in UC, clinical and endoscopic postoperative recurrence in CD can happen in the neoterminal ileum in as many as 90% of patients within 12 months of surgical resection and up to 50% of patients can develop a recurrence of symptoms by 5 years. 74 – 79 Infliximab has been used with good results for prevention of clinical and endoscopic postoperative recurrence in CD. 75 – 79 …”

Section: Infliximab In Other Specific Ibd Clinical Scenariosmentioning

confidence: 99%

Infliximab in inflammatory bowel disease

Papamichael

Lin

Moore

et al. 2019

Therapeutic Advances in Chronic Disease

103

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Anti-tumor necrosis factor (TNF) therapy has revolutionized the medical treatment of the inflammatory bowel diseases (IBD), Crohn’s disease (CD), and ulcerative colitis. Twenty years ago, infliximab became the first anti-TNF agent approved for IBD. Data from randomized controlled trials, large observational cohort studies, postmarketing registries, and meta-analyses show that infliximab is a very effective treatment for moderate to severe IBD with a good safety profile. Infliximab has been also used to treat pouchitis following an ileal pouch–anal anastomosis (IPAA) after restorative proctocolectomy and to prevent postoperative recurrence following an ileocolonic resection for CD with good results. Nevertheless, up to 30% of patients show no clinical benefit following induction and up to 50% lose response over time. Both these unwanted outcomes can be largely explained by inadequate drug concentrations and frequently by the development of antibodies to infliximab. Loss of response can be managed efficiently and often prevented by applying therapeutic drug monitoring. Recently, the first biosimilars of infliximab have been approved and are utilized in clinical practice with comparable efficacy and safety with the originator. This review will mainly focus on the efficacy of infliximab in IBD.

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Comparative Efficacy of Anti-TNF Therapies For The Prevention of Postoperative Recurrence of Crohn’s Disease

Abstract: On the basis of a NMA combining direct and indirect evidence either adalimumab or infliximab may be used in the postoperative prophylaxis of CD recurrence. There is currently a lack of evidence on the use of other anti-TNF agents in this setting.

Cited by 18 publications

References 34 publications

Does anti‐tumor necrosis factor alpha prevent the recurrence of Crohn's disease? Systematic review and meta‐analysis

Does anti‐tumor necrosis factor alpha prevent the recurrence of Crohn's disease? Systematic review and meta‐analysis

Associations Between Obesity and the Effectiveness of Anti–Tumor Necrosis Factor-α Agents in Inflammatory Bowel Disease Patients: A Literature Review and Meta-analysis

Infliximab in inflammatory bowel disease

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