A meta-analysis of the therapeutic effects of tumor necrosis factor-α blockers on ulcerative colitis
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To evaluate the therapeutic effects of TNF-α blockers on ulcerative colitis (UC) and their safety.
Randomized controlled trials (RCTs) of TNF-α blockers for treatment of UC were retrieved from databases. Heterogeneity test was performed on all data to select effects models. Finally, sensitivity analysis was carried out, and a funnel plot was drawn to evaluate publication bias.
A total of nine RCTs conformed to the inclusion criteria. Of 1,226 patients with UC, 806 were given a TNF-α blocker, and 420 were given placebo or other drugs as control. Infliximab was used in eight papers and adalimumab in one paper. Placebo was used in seven papers and hormones in two papers. Short-term response, short-term relief, long-term response, and long-term relief were better in the TNF-α blocker group than in the control group (P < 0.05). TNF-α blockers decreased the colectomy rate (P < 0.05). There were no significant differences in mucosal healing and quality of life between the two groups (P > 0.05). The rates of adverse reactions were similar in the two groups (P > 0.05), but the rate of severe adverse reactions was significantly lower in the TNF-α blocker group than in the control group (P < 0.05). The funnel plot of each parameter was symmetrical with the lower part broader than the upper.
TNF-α blockers have better therapeutic effects on moderate or severe UC, which shows little response to conventional therapy. TNF-α blockers can induce short-term response, maintain long-term clinical response and clinical relief, and decrease the colectomy rate and the severe adverse reaction rate, but they fail to improve quality of life and mucosal healing.
KeywordsUlcerative colitis Tumor necrosis factor-α blocker Meta-analysis Therapeutic effects
- 5.Rahimi R, Nikfar S, Abdollahi M (2007) Meta-analysis technique confirms the effectiveness of anti-TNF-alpha in the management of active ulcerative colitis when administered in combination with corticosteroids. Med Sci Monit 13:I13–I118Google Scholar
- 7.Ford AC, Sandborn WJ, Khan KJ et al (2011) Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 106:644–659Google Scholar
- 16.Reinisch W, Sandborn WJ, Hommes DW et al (2010) Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis. Gastroenterology 138(suppl 1):114–115Google Scholar
- 30.Leung Y, Hanauer SB (2009) Conventional treatment in inflammatory bowel disease—recent trends. Immunosuppressants and biologic agents: should they or need they be used together? How to use immunosuppressive therapy better (and safer) tomorrow? Gastroenterol Clin Biol 33(Suppl 3):S202–S208PubMedCrossRefGoogle Scholar