scholarly journals Will the Inducing and Maintaining Remission of Non-biological Agents and Biological Agents Differ for Crohn's Disease? The Evidence From the Network Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Mingjun Rui ◽  
Zhengyang Fei ◽  
Yingcheng Wang ◽  
Fenghao Shi ◽  
Rui Meng ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biological Agents ◽  
Biologic Agents ◽  
Controlled Trials ◽  
Second Line Therapy ◽  
Randomized Controlled ◽  
First Line Therapy ◽  
Line Therapy ◽  
Maintenance Of Remission

Background: Several drugs currently are available for the treatment of Crohn's disease, including non-biological agents such as anti-inflammatory agents, steroids, immunosuppressive agents, and biologic agents such as anti-tumor necrosis factor (TNF), anti-α4β7 integrin, anti-alpha-4 integrin and anti-interleukin 12/23. However, the choice of treatments for induction and maintenance is still a challenge. The relevant comparison between non-biologic agents and biologic agents is few. In our research, we aimed to help making decisions, as well as providing clinicians and patients with medication references.Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of controlled trials for relevant randomized controlled trials published through to July 2020 and systematic reviews published from January 2011 to December 2020. Search results were screened by 2 independent reviewers first by title and abstract and then by full text. Disagreements were resolved through discussion with a third reviewer.Results: 54 randomized controlled trials were included in our analysis. For induction of remission, azathioprine (OR, 3.5; 95% Crl, 1.4–8.9), infliximab (OR, 4.1; 95% Crl, 1.2–16.0), infliximab + azathioprine (OR, 7.0; 95% Crl, 1.2–41.0) and infliximab+ methotrexate (OR, 7.8; 95% Crl, 1.2–65.0) were more effective in first-line therapy than placebo. Adalimumab showed superiority to placebo in second-line therapy, but the range of SD was wide. For maintenance of remission, adalimumab (OR,2.24;95% Crl,1.17–4.76) and azathioprine (OR,2.05; 95% Crl,1.14–3.96) were more effective than placebo. Adalimumab (OR,0.56; 95%Crl,0.27–1.2), budesonide (OR,0.63; 95%Crl,0.26–1.6) and natalizumab (OR,0.65; 95%Crl,0.30–1.4) was associated with less risk of withdrawals when compared with placebo.Conclusion: For induction of remission, azathioprine, infliximab, and infliximab + azathioprine were more effective in first-line therapy. In second-line therapy, adalimumab was more effective but should be interpreted carefully. For maintenance of remission, adalimumab and azathioprine were more effective. Besides, adalimumab, budesonide, natalizumab had lower withdrawals. Therefore, biological agents were not always better than non-biological agents and they have their own advantages in different treatment methods of Crohn's disease.

scholarly journals Epithelial Cell Biomarkers Are Predictive of Response to Biologic Agents in Crohn’s Disease

2020 ◽  
Author(s):  
Mark T Osterman ◽  
Kelli L VanDussen ◽  
Ilyssa O Gordon ◽  
Elisabeth M Davis ◽  
Katherine Li ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Epithelial Cell ◽  
Crohn's Disease ◽  
Clinical Response ◽  
Predictive Value ◽  
Controlled Trial ◽  
Biologic Agents ◽  
Intestinal Epithelial ◽  
Randomized Controlled ◽  
Discriminant Ability

Abstract Background Therapeutic efficacy of biologics has remained at about 50% for 2 decades. In Crohn’s disease (CD) patients, we examined the predictive value of an epithelial cell biomarker, ileal microvillar length (MVL), for clinical response to ustekinumab (UST) and vedolizumab (VDZ) and its relationship to another biomarker, intestinal epithelial cell (IEC) pyroptosis, with respect to response to VDZ. Method Ileal biopsies from the UNITI-2 randomized controlled trial were analyzed for MVL as a predictor of clinical response to UST. In a 5-center academic retrospective cohort of CD patients, ileal MVL was analyzed to determine its predictive value for response to VDZ. Correlation between ileal MVL and IEC pyroptosis was determined, and the discriminant ability of the combination of 2 biomarkers to VDZ was examined. Results Clinical response in UST was significantly higher than placebo (65% vs 39%; P = 0.03), with patients with normal MVL (>1.7 µm) having the greatest therapeutic effect: 85% vs 20% (P = 0.02). For VDZ, clinical response with MVL of 1.35 to 1.55 µm was 82% vs 44% (<1.35 µm) and 40% (>1.55 µm; P = 0.038). There was no correlation between ileal MVL and IEC pyroptosis. The combination criteria of ileal pyroptosis <14 positive cells/1000 IECs or MVL of 1.35 to 1.55 µm could identify 84% of responders and 67% of nonresponders (P = 0.001). Conclusion Ileal MVL was predictive of response to UST and VDZ in prospective and retrospective CD cohorts. It was independent of ileal IEC pyroptosis, and combination of the 2 biomarkers enhanced the discriminate ability of responders from nonresponders to VDZ.

Randomized Controlled Trials in Prevention of PostSurgical Recurrence in Crohn's Disease

2012 ◽  
Vol 7 (4) ◽  
pp. 307-313
Author(s):  
Claudio Papi ◽  
Federica Fasci Spurio ◽  
Giovanna Margagnoni ◽  
Annalisa Aratari
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Postsurgical Recurrence

Efficacy of adalimumab as first-line therapy in pediatric Crohn's disease

2017 ◽  
Vol 49 (4) ◽  
pp. e261
Author(s):  
L. Zenzeri ◽  
B. Pigneur ◽  
L. Norsa ◽  
E. Farinelli ◽  
S. Esposito ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy
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