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

Uchino, Motoi; Ikeuchi, Hiroki; Hata, Keisuke; Minagawa, Tomonori; Horio, Yuki; Kuwahara, Ryuichi; Nakamura, Shirô; Watanabe, Kenji; Saruta, Masayuki; Fujii, Toshimitsu; Sugimoto, Ken; Hirai, Fumihito; Esaki, Motohiro; Hiraoka, Sakiko; Matsuoka, Katsuyoshi; Shinzaki, Shinichiro; Matsuura, Minoru; Inoue, Nagamu; Nakase, Hiroshi; Watanabe, Mamoru

doi:10.1111/jgh.15288

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…We performed a systematic review and meta-analysis of a total of 570 patients, including 254 in an intervention group and 316 in a control group [ 225 ]. The results of eight randomized control studies performed to determine efficacy of anti-TNF-α agents administered after surgery for the prevention of endoscopic recurrence [relative risk (RR) 0.34, 95% CI 0.22–0.53] showed no increase in AEs (RR 1.75, 95% CI 0.81–3.79).…”

Section: Anti-tnf-α Agentsmentioning

confidence: 99%

“…The results of eight randomized control studies performed to determine efficacy of anti-TNF-α agents administered after surgery for the prevention of endoscopic recurrence [relative risk (RR) 0.34, 95% CI 0.22–0.53] showed no increase in AEs (RR 1.75, 95% CI 0.81–3.79). However, clinical recurrence was not prevented (RR 0.60, 95% CI 0.36–1.02) [ 225 ].…”

Section: Anti-tnf-α Agentsmentioning

confidence: 99%

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Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

et al. 2021

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Inflammatory bowel disease (IBD) is a general term for chronic or remitting/relapsing inflammatory diseases of the intestinal tract and generally refers to ulcerative colitis (UC) and Crohn’s disease (CD). Since 1950, the number of patients with IBD in Japan has been increasing. The etiology of IBD remains unclear; however, recent research data indicate that the pathophysiology of IBD involves abnormalities in disease susceptibility genes, environmental factors and intestinal bacteria. The elucidation of the mechanism of IBD has facilitated therapeutic development. UC and CD display heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management depends on the understanding and tailoring of evidence-based interventions by physicians. In 2020, seventeen IBD experts of the Japanese Society of Gastroenterology revised the previous guidelines for IBD management published in 2016. This English version was produced and modified based on the existing updated guidelines in Japanese. The Clinical Questions (CQs) of the previous guidelines were completely revised and categorized as follows: Background Questions (BQs), CQs, and Future Research Questions (FRQs). The guideline was composed of a total of 69 questions: 39 BQs, 15 CQs, and 15 FRQs. The overall quality of the evidence for each CQ was determined by assessing it with reference to the Grading of Recommendations Assessment, Development and Evaluation approach, and the strength of the recommendation was determined by the Delphi consensus process. Comprehensive up-to-date guidance for on-site physicians is provided regarding indications for proceeding with the diagnosis and treatment.

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Section: Anti-tnf-α Agentsmentioning

confidence: 99%

Section: Anti-tnf-α Agentsmentioning

confidence: 99%

Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

et al. 2021

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“…Although the body of evidence is relatively small, the prophylactic use of anti-TNF has been reported to prevent clinical and endoscopic recurrence in the first 2 years, yet the effect on long-term outcomes remains elusive. 63 The immunological mechanisms underlying recurrence after macroscopic resetting are still being investigated but may involve upregulation of several genes (TNF-α, IFNγ, IL23A, and IL17A) and pathways (mitochondrial dysfunction and JAK-STAT). 64 …”

Section: Early Intervention and Impact On Prognosismentioning

confidence: 99%

A scoping review on early inflammatory bowel disease: definitions, pathogenesis, and impact on clinical outcomes

Estevinho

Moreira

Silva

et al. 2022

Therap Adv Gastroenterol

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Background: Crohn’s disease (CD) and ulcerative colitis (UC) arise from a dysregulation of the balance between commensal microbiota and mucosal-associated immune system, in patients with genetic and environmental predisposition. Different pathophysiological mechanisms have been reported to influence disease history, with impact on disease phenotype and risk of complications. Objectives: This review aims to summarize the definitions of early CD and UC, analyze the underlying immunological mechanisms, and evaluate the impact of recognizing and treating early inflammatory bowel disease (IBD) on patients’ prognosis (short- and long-term outcomes). Design: To address this issue, we have performed a scoping review. Data sources and methods: Three online databases (MEDLINE, Web of Science, and ScienceDirect) were searched and the results were independently screened by two reviewers. Results: From 683 records identified, 42 manuscripts evaluating early IBD in adult patients were included. The ‘early CD’ concept was first described in 2008. Four years later, an international consensus proposed the definition of diagnosis up to 18 months, in patients without previous or current need for disease-modifying therapies. Several other definitions have been proposed; the ‘2 years since diagnosis’ is the most used, regardless of disease characteristics or medication. The amount of evidence on early UC is lower and more recent. Regarding early disease pathogenesis, most theories emphasize the prominent role of innate immunity, followed by early-Th1 adaptive response. Conclusion: The treatment of early CD seems to be crucial for the management of CD patients, impacting short-, medium-, and long-term outcomes. On the other hand, the early treatment of UC appears to be less advantageous, yet evidence comes from only a few retrospective studies.

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“…A meta‐analysis showed that anti‐TNF‐α agents prevented endoscopic recurrence (RR: 0.34) but not clinical recurrence (RR: 0.60, not significant [n.s.]). Patients receiving anti‐TNFα therapy experienced more adverse effects than those who were not (RR: 1.75) 19 . Curcumin, as an adjuvant treatment for mesalamine, was proven to be effective in inducing clinical remission (odds ratio [OR]: 5.2), endoscopic remission (OR: 5.7), and endoscopic improvement (OR: 17.1), and was shown to be safe in UC 20 …”

Section: Ibdmentioning

confidence: 99%

“…Patients receiving anti-TNFα therapy experienced more adverse effects than those who were not (RR: 1.75). 19 Curcumin, as an adjuvant treatment for mesalamine, was proven to be effective in inducing clinical remission (odds ratio [OR]: 5.2), endoscopic remission (OR: 5.7), and endoscopic improvement (OR:…”

Section: Periodontitismentioning

confidence: 99%

Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

Shinmoto

Miyamoto

Yoshida

et al. 2022

Annals of Gastroent Surgery

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The development of new drugs for inflammatory bowel disease (IBD) is remarkable, and treatment strategies using multiple agents and various techniques are required; however, the treatment strategy is likely to be complex. Therefore, appropriate evaluation of traditional surgical treatment strategies and accurate knowledge of the efficacy and limitations of novel treatments are required. Total infectious complications were found to be associated with the use of corticosteroids and anti‐tumor necrosis factor‐α agents, but not with immunomodulators, anti‐integrin agents, and 5‐aminosalicylic acid. Regarding surgical procedures for IBD, conceived anastomosis methods, including Kono‐S for Crohn's disease stenosis, are associated with better outcomes than conventional techniques. Autologous cell transplantation for Crohn's fistulae has been shown to have a favorable outcome. Diverticulitis is increasing and will be treated more frequently in the future. Risk factors for the incidence of diverticulitis and differences in pathogenesis according to right or left side diverticulitis have been reported. Antibiotic therapy may be omitted for uncomplicated diverticulitis. Moreover, regarding surgical procedures, both bowel resection and anastomosis are associated with favorable short‐term outcomes, higher stoma closure rate, and superior medical economy compared to Hartmann's procedure. Risk factors for recurrence after diverticulitis surgery may provide better postoperative follow‐up. In this review, we explore the current topics of colorectal benign diseases, focusing on IBD and diverticulitis, based on clinical trials and meta‐analyses from 2020‐2021. This review consolidates the available knowledge and improves the quality of surgical procedures and perioperative management for IBD and diverticulitis.

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

Cited by 8 publications

References 41 publications

Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

A scoping review on early inflammatory bowel disease: definitions, pathogenesis, and impact on clinical outcomes

Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

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