Comparative Efficacy of Novel Biologics, Antitumour Necrosis Factor Agents, and Immunomodulators to Prevent Postoperative Recurrence in Crohn's Disease: A Systematic Review and Network Meta-analysis.
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Abstract
Background and aims: Our objective was to compare the efficacy of novel biologics (like vedolizumab and ustekinumab), anti-tumour necrosis factor agents (anti-TNFs), and immunomodulators (IMMs) in preventing postoperative recurrence (POR) of Crohn's disease (CD).
Methods: We searched PubMed, Embase, and the Cochrane Library databases up to December 2023 to identify placebo-controlled, no-treatment-comparison, or positive-controlled studies for the prevention of POR in CD. Endoscopic and clinical recurrence were the primary and secondary endpoint for the efficacy assessment. We conducted traditional direct and Bayesian network meta-analyses to evaluate the preventive effects of selected drugs. Additionally, we ranked interventions based on their scores under the Surface Under the Cumulative Ranking curve (SUCRA).
Results: A total of 17 studies involving 2786 patients were included. In the direct meta-analysis, anti-TNFs, vedolizumab, and IMMs showed greater efficacy in preventing endoscopic POR, compared to controls (placebo or no treatment). When it came to preventing clinical POR, anti-TNFs and IMMs outperformed controls. The network meta-analysis revealed that the risk of endoscopic POR was considerably lower in patients receiving anti-TNFs, vedolizumab, and ustekinumab compared to controls. Regarding the reduction of clinical POR, only anti-TNFs showed significant efficacy compared to controls. Vedolizumab and anti-TNFs were ranked as the most effective strategies in preventing endoscopic and clinical recurrence, respectively.
Conclusions: According to direct and network meta-analysis, in CD patients after surgical resection, novel biologics, especially vedolizumab, were quite effective in decreasing the risk of endoscopic POR, whereas anti-TNFs appeared to perform best in reducing the risk of clinical POR.
新型生物制剂、抗肿瘤坏死因子制剂和免疫调节剂预防克罗恩病术后复发的疗效比较：系统综述与网络 Meta 分析》。
背景与目的我们的目的是比较新型生物制剂（如维妥珠单抗和乌斯特库单抗）、抗肿瘤坏死因子制剂（anti-TNFs）和免疫调节剂（IMMs）在预防克罗恩病（CD）术后复发（POR）方面的疗效：我们检索了截至 2023 年 12 月的 PubMed、Embase 和 Cochrane Library 数据库，以确定预防 CD 术后复发的安慰剂对照、无治疗比较或阳性对照研究。内镜和临床复发是疗效评估的主要和次要终点。我们进行了传统的直接分析和贝叶斯网络荟萃分析，以评估所选药物的预防效果。此外，我们还根据干预措施在累积排名曲线（Surface Under the Cumulative Ranking curve，SUCRA）下的得分进行了排名：结果：共纳入了 17 项研究，涉及 2786 名患者。在直接荟萃分析中，与对照组（安慰剂或不治疗）相比，抗肿瘤坏死因子、维多利珠单抗和IMM在预防内镜下POR方面显示出更大的疗效。在预防临床POR方面，抗肿瘤坏死因子和IMMs的疗效优于对照组。网络荟萃分析显示，与对照组相比，接受抗肿瘤坏死因子、维妥珠单抗和乌司替尼治疗的患者发生内镜下POR的风险要低得多。在降低临床 POR 方面，与对照组相比，只有抗肿瘤坏死因子具有显著疗效。在预防内镜复发和临床复发方面，维多珠单抗和抗肿瘤坏死因子分别被评为最有效的策略：根据直接分析和网络荟萃分析，对于手术切除后的 CD 患者，新型生物制剂，尤其是维多珠单抗，在降低内镜下 POR 风险方面相当有效，而抗 TNFs 在降低临床 POR 风险方面似乎表现最佳。
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