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Meta-Analysis
. 2021 Aug 3;21(1):312.
doi: 10.1186/s12876-021-01883-6.

Systematic review and meta-analysis: real-world data rates of deep remission with anti-TNFα in inflammatory bowel disease

Omeed Alipour  1 , Alakh Gualti  2 , Ling Shao  3 , Bing Zhang  4   5
Affiliations
Meta-Analysis

Systematic review and meta-analysis: real-world data rates of deep remission with anti-TNFα in inflammatory bowel disease

Omeed Alipour et al. BMC Gastroenterol. .

Abstract

Background: Deep remission (DR) is a treatment target in IBD associated with reduced hospitalization and improved outcome. Randomized control trial (RCT) data demonstrates efficacy of anti-TNFα agents in achieving DR; however, real-world data (RWD) can provide information complementary to RCTs, specifically regarding treatment duration. In this systematic review with meta-analysis, we use real-world data (RWD) to determine rates of DR in IBD treated with anti-TNFα.

Methods: We completed a systematic search of MEDLINE and EMBASE on July 8, 2019 with review of major gastrointestinal conference abstracts from 2012 to 2019. Studies utilizing RWD (data not from phase I-III RCTs) of adult IBD patients treated with anti-TNFα agents were included. DR was defined by clinical and endoscopic remission at minimum. DR was assessed at 8 weeks, 6 months, 1 year, and 2 years. Risk of bias was assessed with the Newcastle Ottawa Scale.

Results: 29,033 publications were identified. Fifteen publications, nine manuscripts and six conference abstracts, were included encompassing 1212 patients (769 Crohn's disease-CD, 443 ulcerative colitis-UC), and analyzed using Comprehensive Meta-Analysis. Rate of DR was 36.4% (95% CI 12.6-69.4%) at 8 weeks, 39.1% (95% CI 10.4-78%) at 6 months, 44.4% (95% CI 34.6-54.6%) at 1 year, and 36% (95% CI 18.7-58%) at 2 years. DR in CD at 1 year was 48.6% (95% CI 32.8-64.7%) and in UC was 43.6% (95% CI 32.8-55.1%).

Conclusions: The rate of DR was highest after 1 year of therapy, in nearly 45% of IBD patients treated with anti-TNFα. Similar rates were achieved between patients with UC and CD. The findings highlight the efficacy of anti-TNFα in real-world setting. Future studies using RWD can determine efficacy of newer IBD therapeutics in routine clinical practice.

Keywords: Crohn’s disease; Inflammatory bowel disease; Remission; Tumor necrosis factor-a inhibitor; Ulcerative colitis.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA diagram
Fig. 2
Fig. 2
Rates of deep remission in IBD at 8 weeks, 6 months, 1 year, and 2 years
Fig. 3
Fig. 3
Rates of deep remission in Crohn’s disease and ulcerative colitis at 1 year
Fig. 4
Fig. 4
Rates of deep remission in IBD in anti-TNF naïve patients at 8 weeks, 6 months, 1 year, and 2 years
Fig. 5
Fig. 5
Rates of deep remission in IBD and CD/UC sub-categories with infliximab
See this image and copyright information in PMC

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