Crohn's disease: infliximab reduces postoperative recurrence in meta-analysis

  • Huang H & al.
  • Biomed Res Int
  • 1 Jan 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Infliximab, starting a few weeks after bowel resection in patients with Crohn's disease (CD), reduces the risk for postoperative recurrence by approximately 50%-60% compared with placebo, according to a meta-analysis.

Why this matters

  • More than 75% of patients with CD need surgical resection over the course of illness.
  • Within 2-6 years of resection, 41% have clinical recurrence and 89% have endoscopic recurrence.

Study design

  • Meta-analysis of 7 prospective placebo-controlled trials (n=455) after a search of Medline, EMBASE, PubMed, and Web of Science.
  • Funding: National Natural Science Foundation of China; others.

Key results

  • Infliximab (vs placebo) was associated with a 57.9% reduction in the risk for endoscopic recurrence (defined as Rutgeerts Score ≥2; relative risk [RR], 0.421; P<.001>
  • Infliximab (vs placebo) was associated with a 48.1% reduction in the risk for clinical recurrence (RR, 0.519; P=.001). Clinical recurrence was defined as Hanauer >2, Crohn's Disease Activity Index >150, or Harvey-Bradshaw Index >8.
  • The most common adverse events in infliximab-treated patients were lupus-like reaction, infusion reaction, bronchitis, nasopharyngitis, pyelonephritis, severe abdominal pain, and abdominal wall abscess.

Limitations

  • Small number of trials, patients.
  • The term "prospective trials" was not defined, except that they were controlled.

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