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Comparative Effectiveness of Immunosuppressants and Biologics for Inducing and Maintaining remission in Crohn's Disease.

DustyKat

DustyKat

Super Moderator
Comparative Effectiveness of Immunosuppressants and Biologics for Inducing and Maintaining remission in Crohn's Disease: A Network Meta-analysis.

Abstract Only:

Background & Aims
There is controversy regarding the best treatment for patients with Crohn’s disease because of the lack of direct comparative trials. We compared therapies for induction and maintenance of remission in patients with Crohn’s disease, based on direct and indirect evidence.

Methods
We performed systematic reviews of MEDLINE, EMBASE, and Cochrane Central databases, through June 2014. We identified randomized controlled trials (N = 39) comparing methotrexate, azathioprine/6-mercaptopurine, infliximab, adalimumab, certolizumab, vedolizumab, or combined therapies with placebo or an active agent for induction and maintenance of remission in adult patients with Crohn’s disease. Pairwise treatment effects were estimated through a Bayesian random-effects network meta-analysis and reported as odds ratios (OR) with a 95% credible interval (CrI).

Results
Infliximab, the combination of infliximab and azathioprine (infliximab + azathioprine), adalimumab, and vedolizumab were superior to placebo for induction of remission. In pair-wise comparisons of anti–tumor necrosis factor agents, infliximab + azathioprine (OR, 3.1; 95% CrI, 1.4–7.7) and adalimumab (OR, 2.1; 95% CrI, 1.0–4.6) were superior to certolizumab for induction of remission. All treatments were superior to placebo for maintaining remission, except for the combination of infliximab and methotrexate. Adalimumab, infliximab, and infliximab + azathioprine were superior to azathioprine/6-mercaptopurine: adalimumab (OR, 2.9; 95% CrI, 1.6–5.1), infliximab (OR, 1.6; 95% CrI, 1.0–2.5), infliximab + azathioprine (OR, 3.0; 95% CrI, 1.7–5.5) for maintenance of remission. Adalimumab and infliximab + azathioprine were superior to certolizumab: adalimumab (OR, 2.5; 95% CrI, 1.4–4.6) and infliximab + azathioprine (OR, 2.6; 95% CrI, 1.3–6.0). Adalimumab was superior to vedolizumab (OR, 2.4; 95% CrI, 1.2–4.6).

Conclusions
Based on a network meta-analysis, adalimumab and infliximab + azathioprine are the most effective therapies for induction and maintenance of remission of Crohn’s disease.

http://www.gastrojournal.org/article/S0016-5085(14)01268-2/abstract
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xeridea

xeridea

For adolescent males, I would still pick MTX over AZA/6MP. I will have to dust them off, but I've read studies that suggest AZA/6MP can cause permanent DNA changes. But I understand that this disease is so different for everyone, and you have to do what you have to do.
 
aideen33

aideen33

Very interesting. we are currently trying a combo azathioprine with adalimumab *fingers crossed* i wonder why the methotrexate remicade combo is less effective .. those two dont play nicely together i guess
 
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