Systematic Review with Network Meta-Analysis: Efficacy of Induction Therapy with a Second Biological Agent in Anti-TNF-Experienced Crohn’s Disease Patients
Joint Authors
Pagnini, Cristiano
Siakavellas, Spyros I.
Bamias, Giorgos
Source
Gastroenterology Research and Practice
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-9, 9 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-07-17
Country of Publication
Egypt
No. of Pages
9
Main Subjects
Abstract EN
Background and Aim.
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract with the potential to progress to a severe debilitating state.
Treatment with biological agents is highly efficient, improving both short-term outcomes and long-term prognosis.
Nonetheless, up to 60% of patients receiving biological therapy will exhibit nonresponse at some point.
The optimal management of such patients is not clearly defined.
Besides traditional anti-TNF agents (infliximab, adalimumab, and certolizumab), alternative biological therapies (natalizumab, vedolizumab, and ustekinumab) are currently available for the treatment of CD.
Our aim was to analyze all available evidence regarding efficacy of a second biological in “biological-treatment-experienced” patients.
Methods.
A systematic review of the literature was conducted using specific criteria for selecting relevant randomized clinical trials evaluating response to administration of secondary biological therapy in “anti-TNF-experienced” CD patients.
Data from these studies was used to perform (a) traditional meta-analysis to ascertain the effect of secondary treatment versus placebo and (b) network meta-analysis to compare indirectly the efficacy of available biological agents.
Results.
Out of initially 977 studies, only eight were included for analysis, providing a total of 1281 treated and 733 placebo-receiving CD patients.
Treatment with a second biological was found to be superior to placebo for both induction of remission (OR 2.2, 95% CI 1.7 to 3) and response (OR 1.9, 95% CI 1.5 to 2.5), with global rates of 24% and 42%, respectively (placebo rate: 11% and 27%, p<0.0001 for both).
Indirect comparisons performed with network meta-analysis suggest no specific agent is clearly superior to others, with relatively better results observed for adalimumab in inducing disease remission.
Conclusion.
In anti-TNF-experienced CD patients, secondary biological administration may be efficient, while no specific agent seems to outperform the others.
Further research is needed to identify optimal management strategies for this challenging subset of patients.
American Psychological Association (APA)
Pagnini, Cristiano& Siakavellas, Spyros I.& Bamias, Giorgos. 2018. Systematic Review with Network Meta-Analysis: Efficacy of Induction Therapy with a Second Biological Agent in Anti-TNF-Experienced Crohn’s Disease Patients. Gastroenterology Research and Practice،Vol. 2018, no. 2018, pp.1-9.
https://search.emarefa.net/detail/BIM-1165277
Modern Language Association (MLA)
Pagnini, Cristiano…[et al.]. Systematic Review with Network Meta-Analysis: Efficacy of Induction Therapy with a Second Biological Agent in Anti-TNF-Experienced Crohn’s Disease Patients. Gastroenterology Research and Practice No. 2018 (2018), pp.1-9.
https://search.emarefa.net/detail/BIM-1165277
American Medical Association (AMA)
Pagnini, Cristiano& Siakavellas, Spyros I.& Bamias, Giorgos. Systematic Review with Network Meta-Analysis: Efficacy of Induction Therapy with a Second Biological Agent in Anti-TNF-Experienced Crohn’s Disease Patients. Gastroenterology Research and Practice. 2018. Vol. 2018, no. 2018, pp.1-9.
https://search.emarefa.net/detail/BIM-1165277
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1165277