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. 2014 Jun;39(12):1349-62.
doi: 10.1111/apt.12749. Epub 2014 Apr 20.

Systematic review with network meta-analysis: the efficacy of anti-TNF agents for the treatment of Crohn's disease

R W Stidham  1 , T C H Lee, P D R Higgins, A R Deshpande, D A Sussman, A G Singal, B J Elmunzer, S D Saini, S Vijan, A K Waljee
Affiliations

Systematic review with network meta-analysis: the efficacy of anti-TNF agents for the treatment of Crohn's disease

R W Stidham et al. Aliment Pharmacol Ther. 2014 Jun.

Abstract

Background: Anti-tumour necrosis factor-alpha agents (anti-TNF) are effective therapies for the treatment of Crohn's disease (CD), but their comparative efficacy is unknown.

Aim: To perform a network meta-analysis comparing the efficacy of anti-TNF therapies in CD.

Methods: After screening 506 studies, reviewers extracted information on 10 studies. Traditional meta-analysis (TMA) was used to compare each anti-TNF agent to placebo. Bayesian network meta-analysis (NMA) was performed to compare the effects of anti-TNF agents to placebo. In addition, sample sizes for comparative efficacy trials were calculated.

Results: Compared to placebo, TMA revealed that anti-TNF agents result in a higher likelihood of induction of remission and response (RR: 1.66, 95% CI: 1.17-2.36 and RR: 1.43, 95% CI: 1.17-1.73, respectively) as well as maintenance of remission and response (RR: 1.78, 95% CI: 1.51-2.09 and RR: 1.68, 95% CI: 1.46-1.93, respectively). NMA found nonsignificant trends between infliximab and adalimumab or certolizumab pegol. Among subcutaneous therapies, NMA demonstrated superiority of adalimumab to certolizumab pegol for induction of remission (RR: 2.93, 95% CrI: 1.21-7.75). Sample size calculations suggest that adequately powered head-to-head comparative efficacy trials would require greater than 3000 patients.

Conclusions: All anti-TNF agents are effective for induction and maintenance of response and remission in the treatment of CD. Although adalimumab is superior to certolizumab pegol for induction of remission, there is no evidence of clinical superiority among anti-TNF agents. Head-to-head trials among the anti-TNF agents are impractical in terms of size and cost.

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Figures

Figure 1
Figure 1
Study inclusion protocol for induction and maintenance of clinical response and remission in Crohn’s disease.
Figure 2
Figure 2
Panel: Meta-analysis of anti-TNFs for the treatment of Crohn’s disease. (a) Meta-analysis of the induction of remission endpoint. (b) Meta-analysis of the induction of response endpoint. (c) Meta-analysis of the maintenance of remission endpoint. (d) Meta-analysis of the maintenance of response endpoint.
Figure 2
Figure 2
Panel: Meta-analysis of anti-TNFs for the treatment of Crohn’s disease. (a) Meta-analysis of the induction of remission endpoint. (b) Meta-analysis of the induction of response endpoint. (c) Meta-analysis of the maintenance of remission endpoint. (d) Meta-analysis of the maintenance of response endpoint.
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