In people with Crohn’s disease, several treatments prevent disease relapse after surgery

Singh S, Garg SK, Pardi DS, et al. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn`s disease after surgery: a systematic review and network meta-analysis. Gastroenterology. 2015;148:64-76.

Review question

In people with Crohn’s disease, which treatments prevent disease relapse after surgery?

Background

Crohn’s disease causes inflammation of the lining of the digestive tract. This can cause abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Drug treatments can improve symptoms of Crohn’s disease and can often result in long-term remission. However, about half of people with the disease will need surgery to remove diseased parts of the small bowel or colon within 10 years of diagnosis. Afterwards, they will be given drug treatments to help prevent relapse.

How the review was done

The researchers did a systematic review, searching for studies that were published up to March 2014.

They found 21 randomized controlled trials with 2,006 people.

The key features of the trials were:

• people had established Crohn’s disease and surgery to remove visible disease from the small bowel or colon;
• within 3 months of surgery, people started treatment with mesalamine, antibiotics, budesonide), immunomodulators (azathioprine or 6-mercaptopurine), or anti–tumor necrosis factor agents (e.g., infliximab, adalimumab) for preventing relapse;
• treatments were compared with another active agent, placebo, or no intervention;
• people were followed for at least 6 months after surgery.

Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.

What the researchers found

Compared with placebo:

• mesalamine, antibiotics, immunomodulators alone or with antibiotics, and anti–tumor necrosis factor agents reduced clinical relapse;
• budesonide did not reduce clinical relapse.

Anti–tumor necrosis factor agents reduced clinical relapse more than other treatments.

The risk of medication discontinuation as a result of adverse events did not differ for antibiotics and immunomodulators, alone or in combination, or for anti–tumor necrosis factor agents as a single treatment.

Conclusions

In people with Crohn’s disease, several drug treatments prevent disease relapse after surgery. Anti–tumor necrosis factor agents appear to have the greatest effect on clinical relapse.

Treatment vs placebo for the prevention of clinical relapse after surgery for Crohn’s disease

*Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.