Efficacy of tumour necrosis factor antagonists on remission, colectomy and hospitalisations in ulcerative colitis: Meta-analysis of placebo-controlled trials.

Abstract

BACKGROUND:

The potential for disease modification of tumour necrosis factor antagonists in ulcerative colitis remains debated.

METHODS:

We searched MEDLINE, the Cochrane Library and EMBASE. Clinical response/remission, mucosal healing, colectomy, disease-related hospitalisations, and adverse events were analysed by the methods of Peto and Der Simonian and Laird.

RESULTS:

Five trials enrolled 3654 patients (anti-tumour necrosis factor=2338). Anti-tumour necrosis factor therapy was more effective than placebo to induce and maintain clinical remission, with a number needed to treat of 12 (95% confidence interval [CI], 7-35) and 6 (95% CI, 4-12) for adalimumab and infliximab, respectively. Anti-tumour necrosis factor therapy was more effective than placebo to induce and maintain mucosal healing, with number needed to treat of 9 (95% CI, 5-48), 7 (95% CI, 5-17), 4 (95% CI, 3-6) for adalimumab, golimumab and infliximab, respectively. Only infliximab was associated with a reduced need for colectomy. Both infliximab and adalimumab were associated with less hospitalisations. Anti-tumour necrosis factor therapy did not increase the risk of adverse events.

CONCLUSIONS:

Anti-tumour necrosis factor therapy is more effective than placebo to induce and maintain clinical remission and mucosal healing. Both infliximab and adalimumab are associated with less hospitalisations. Infliximab reduces the need for colectomy. Anti-tumour necrosis factor therapy does not increase the risk of adverse events.

• Authors: Anthony Lopez, Alexander C Ford, Jean-Frédéric Colombel, Walter Reinisch, William J Sandborn, Laurent Peyrin-Biroulet
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 47 Issue 5 Pg. 356-64 (May 2015) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 25661014 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Inflammatory Agents
• Placebos
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• Clinical Trials as Topic
• Colectomy (statistics & numerical data)
• Colitis, Ulcerative (drug therapy, pathology, surgery)
• Hospitalization (statistics & numerical data)
• Humans
• Infliximab (therapeutic use)
• Intestinal Mucosa (drug effects, pathology)
• Placebos (administration & dosage)
• Remission Induction
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)