ABSTRACT

Background

Approximately half of patients with Crohn’s disease (CD) may inevitably receive surgical intervention as the disease progress. However, about 75% of CD patients will experience postoperative recurrence (POR). Biologics are appealing alternatives for the prevention of POR; however, it is still unclear which biological agents are more efficient. This meta-analysis aimed to investigate the efficacy of biologics for POR prevention and to compare the superiority of different biologics.

Methods

We conducted a thorough search of online databases and screened for studies on the efficacy of biologics in preventing POR (clinical, endoscopic, or histological) that were published until January 2021. The results were presented as forest plots and odds ratios (ORs) with 95% confidence intervals (CIs).

Results

We included 26 studies with 2,136 participants. Overall, biologics were more efficient over non-biological treatments in preventing endoscopic, severe endoscopic, and clinical POR without increasing the frequency of adverse events. Among the various types of biologics, anti-TNFα agents were better than vedolizumab in preventing endoscopic POR. Moreover, infliximab had a similar curative effect to adalimumab in preventing endoscopic, severe endoscopic, and clinical recurrence.

Conclusion

Biologics, especially anti-TNFα agents, still play a vital role in preventing POR in the biological era.

中文翻译：

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抗-TNFα药物在预防克罗恩病术后复发中的作用：它们在生物时代仍然发挥作用吗？

摘要

背景

随着疾病的进展，大约一半的克罗恩病 (CD) 患者可能不可避免地接受手术干预。然而，大约 75% 的 CD 患者会出现术后复发 (POR)。生物制剂是预防 POR 的有吸引力的替代品；然而，目前尚不清楚哪种生物制剂更有效。这项荟萃分析旨在调查生物制剂预防 POR 的功效，并比较不同生物制剂的优越性。

方法

我们对在线数据库进行了彻底搜索，并筛选了截至 2021 年 1 月发表的关于生物制剂预防 POR（临床、内窥镜或组织学）功效的研究。结果以森林图和优势比 (OR) 的形式呈现，其中 95 % 置信区间 (CI)。

结果

我们纳入了 26 项研究，共有 2,136 名参与者。总体而言，生物制剂在预防内窥镜、严重内窥镜和临床 POR 方面比非生物治疗更有效，而不会增加不良事件的发生频率。在各类生物制剂中，抗 TNFα 药物在预防内镜 POR 方面优于维多珠单抗。此外，英夫利昔单抗在预防内镜下、严重内镜下和临床复发方面的疗效与阿达木单抗相似。

结论

生物制品，尤其是抗 TNFα 药物，在生物时代仍然在预防 POR 方面发挥着至关重要的作用。