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Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis

Alexander C Ford1, William J Sandborn, Khurram J Khan

  • 1Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK. alexf12399@yahoo.com

The American Journal of Gastroenterology
|March 17, 2011
PubMed

Insights

Biological therapies, including anti-tumor necrosis factor-α (TNFα) antibodies and natalizumab, effectively induce remission in Crohn's disease (CD) and ulcerative colitis (UC). These treatments also help prevent relapse in quiescent CD patients.

Area of Science:

  • Gastroenterology
  • Immunology
  • Clinical Pharmacology

Background:

  • Crohn's disease (CD) and ulcerative colitis (UC) are idiopathic inflammatory gastrointestinal disorders.
  • Biological therapies offer potential treatment options for CD and UC.
  • A comprehensive systematic review and meta-analysis on biological therapies for CD and UC was lacking.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy of biological therapies in treating Crohn's disease and ulcerative colitis.
  • To compare the effectiveness of anti-tumor necrosis factor-α (TNFα) antibodies and natalizumab against placebo.
  • To assess the impact of biological therapies on inducing remission and preventing relapse in CD and UC patients.

Main Methods:

  • Searched MEDLINE, EMBASE, and Cochrane central register of controlled trials up to December 2010.
  • Included randomized controlled trials of adults with active or quiescent CD or UC comparing biological therapies (anti-TNFα antibodies, natalizumab) with placebo.
  • Pooled dichotomous symptom data to calculate relative risk (RR) of treatment failure or relapse with 95% confidence intervals (CI).

Main Results:

  • Identified 27 eligible studies from 3,061 citations.
  • Anti-TNFα antibodies and natalizumab demonstrated superiority over placebo in inducing remission for luminal CD.
  • Anti-TNFα antibodies were also effective in preventing relapse in quiescent luminal CD.
  • Infliximab showed superiority over placebo in inducing remission for moderate to severe active UC.

Conclusions:

  • Biological therapies are significantly more effective than placebo for inducing remission in active CD and UC.
  • Biological therapies are effective in preventing relapse of quiescent CD.
  • The findings support the use of biological therapies in managing inflammatory bowel diseases.
Abstract

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