Systematic review with network meta‐analysis: the efficacy of anti‐TNF agents for the treatment of Crohn's disease. Issue 12 (20th April 2014)

• Record Type: Journal Article
• Authors: Stidham, R. W.; Lee, T. C. H.; Higgins, P. D. R.; Deshpande, A. R.; Sussman, D. A.; Singal, A. G.; Elmunzer, B. J.; Saini, S. D.; Vijan, S.; Waljee, A. K.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 39:Issue 12(2014)
• Page Start: 1349
• Page End: 1362
• Publication Date: 2014-04-20
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12749
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12749-abs-0001"> <title>Summary</title> <sec id="apt12749-sec-0001" sec-type="section"> <title>Background</title> <p>Anti‐tumour necrosis factor‐alpha agents (anti‐TNF) are effective therapies for the treatment of Crohn's disease (CD), but their comparative efficacy is unknown.</p> </sec> <sec id="apt12749-sec-0002" sec-type="section"> <title>Aim</title> <p>To perform a network meta‐analysis comparing the efficacy of anti‐TNF therapies in CD.</p> </sec> <sec id="apt12749-sec-0003" sec-type="section"> <title>Methods</title> <p>After screening 506 studies, reviewers extracted information on 10 studies. Traditional meta‐analysis (TMA) was used to compare each anti‐TNF agent to placebo. Bayesian network meta‐analysis (NMA) was performed to compare the effects of anti‐TNF agents to placebo. In addition, sample sizes for comparative efficacy trials were calculated.</p> </sec> <sec id="apt12749-sec-0004" sec-type="section"> <title>Results</title> <p>Compared to placebo, TMA revealed that anti‐TNF agents result in a higher likelihood of induction of remission and response (RR: 1.66, 95% CI: 1.17–2.36 and RR: 1.43, 95% CI: 1.17–1.73, respectively) as well as maintenance of remission and response (RR: 1.78, 95% CI: 1.51–2.09 and RR: 1.68, 95% CI: 1.46–1.93, respectively). NMA found nonsignificant trends between infliximab and adalimumab or certolizumab pegol. Among subcutaneous therapies, NMA demonstrated superiority of adalimumab to certolizumab pegol for induction of remission (RR: 2.93, 95% CrI: 1.21–7.75). Sample size calculations suggest that adequately powered head‐to‐head comparative efficacy trials would require greater than 3000 patients.</p> </sec> <sec id="apt12749-sec-0005" sec-type="section"> <title>Conclusions</title> <p>All anti‐TNF agents are effective for induction and maintenance of response and remission in the treatment of CD. Although adalimumab is superior to certolizumab pegol for induction of remission, there is no evidence of clinical superiority among anti‐TNF agents. Head‐to‐head trials among the anti‐TNF agents are impractical in terms of size and cost.</p> </sec> </abstract>