Anti -TNFα agents in preventing the postoperative recurrence of Crohn’s disease: Do they still play a role in the biological era?

ABSTRACT

Background

Approximately half of patients with Crohn’s disease (CD) may inevitably receive surgical intervention as the disease progress. However, about 75% of CD patients will experience postoperative recurrence (POR). Biologics are appealing alternatives for the prevention of POR; however, it is still unclear which biological agents are more efficient. This meta-analysis aimed to investigate the efficacy of biologics for POR prevention and to compare the superiority of different biologics.

Methods

We conducted a thorough search of online databases and screened for studies on the efficacy of biologics in preventing POR (clinical, endoscopic, or histological) that were published until January 2021. The results were presented as forest plots and odds ratios (ORs) with 95% confidence intervals (CIs).

Results

We included 26 studies with 2,136 participants. Overall, biologics were more efficient over non-biological treatments in preventing endoscopic, severe endoscopic, and clinical POR without increasing the frequency of adverse events. Among the various types of biologics, anti-TNFα agents were better than vedolizumab in preventing endoscopic POR. Moreover, infliximab had a similar curative effect to adalimumab in preventing endoscopic, severe endoscopic, and clinical recurrence.

Conclusion

Biologics, especially anti-TNFα agents, still play a vital role in preventing POR in the biological era.

KEYWORDS:

• Crohn’s disease
• biologics
• biological era
• postoperative recurrence

Data availability statement

The data underlying this article are available in the article and in its online supplementary material.

Author contributions

Guarantor of the article: Xiaojun Zhuang. Xiaojun Zhuang and Zhirong Zeng designed the study. Caiguang Liu wrote the manuscript. Caiguang Liu, Shukai Zhan and Na Li collected the data. Caiguang Liu, Dongxuan Wu and Tong Li analyzed the data. Zhirong Zeng and Xiaojun Zhuang revised the manuscript. All authors participated in the preparation and review of the manuscript. All authors read and approved the final version of the manuscript.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper is supported by the GuangDong Basic and Applied Basic Research Foundation (2020A1515111087).