Antitumor necrosis factor a is more effective than conventional medical therapy for the prevention of postoperative recurrence of Crohn's disease: a meta-analysis

Background There have seen several studies evaluating the efficacy of anti-tumor necrosis factor alpha (anti-TNF alpha) compared with conventional therapy (i.e. immunomodulators, mesalamine, or placebo) at preventing postoperative Crohn's disease (CD) recurrence. The results of these studies have been variable and the magnitude by which anti-TNF alpha therapy alters the natural history of CD in the postoperative setting has not yet been fully defined. Methods A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (May 2014). All studies on adult patients with CD that compared anti-TNF alpha therapy versus conventional therapy or placebo to prevent CD recurrence were included. Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess for clinical remission. Results In the pooled analysis, there was a higher frequency of achieving clinical remission beyond 1 year from time of surgery among patients receiving anti-TNF alpha therapy compared with conventional therapy [OR 6.41; 95% confidence interval (CI) 2.88-14.27]. There was also a significantly higher rate of achieving both endoscopic OR 26.44; 95% CI 10.48-66.68) and histologic remission (OR 9.80; 95% CI 2.54-37.81) in the anti-TNF alpha therapy group compared with the conventional therapy group. Conclusion Anti-TNF alpha therapy is more effective at preventing clinical, endoscopic, and histologic recurrence of CD beyond 1 year from time of surgery compared with conventional therapy. (C) 2014 Wolters Kluwer Health broken vertical bar Lippincott Williams & Wilkins.