PMID- 33002235 OWN - NLM STAT- MEDLINE DCOM- 20210924 LR - 20210924 IS - 1440-1746 (Electronic) IS - 0815-9319 (Linking) VI - 36 IP - 4 DP - 2021 Apr TI - Does anti-tumor necrosis factor alpha prevent the recurrence of Crohn's disease? Systematic review and meta-analysis. PG - 864-872 LID - 10.1111/jgh.15288 [doi] AB - BACKGROUND AND AIM: Anti-tumor necrosis factor (TNF) alpha agents are now well known to function as effective treatments for Crohn's disease (CD). Several meta-analyses have revealed the efficacy of anti-TNF therapy for preventing recurrence after surgery; however, the efficacies reported in some prospective studies differed according to the outcomes. Moreover, adverse events (AEs) were not well evaluated. We conducted this systematic review and meta-analysis to evaluate both the efficacy of anti-TNF therapy after stratification by the outcome of interest and the AEs. METHODS: We performed a systematic literature review of studies investigating anti-TNF therapy, CD, and postoperative recurrence. Meta-analyses were performed for endoscopic and clinical recurrence and AEs. RESULTS: A total of 570 participants, including 254 patients in the intervention group and 316 patients in the control group, in eight studies, were analyzed for recurrence. Based on the results of the meta-analysis, the efficacies of anti-TNF therapy at preventing endoscopic and clinical recurrence were as follows: relative risk (RR) 0.34, 95% confidence interval (CI) 0.22-0.53 and RR 0.60, 95% CI 0.36-1.02, respectively. The RR of AEs with anti-TNF therapy was 1.75 (95% CI 0.81-3.79). CONCLUSIONS: Anti-TNF therapy after surgery for CD displays efficacy at preventing endoscopic recurrence for 1-2 years, without increasing the incidence of AEs. However, clinical recurrence was not significantly reduced. The efficacy of postoperative anti-TNF therapy may differ in terms of the outcomes, which include long-term prevention, the avoidance of further surgery, and cost-effectiveness. CI - (c) 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. FAU - Uchino, Motoi AU - Uchino M AUID- ORCID: 0000-0002-2934-1680 AD - Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. FAU - Ikeuchi, Hiroki AU - Ikeuchi H AD - Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. FAU - Hata, Keisuke AU - Hata K AD - Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. FAU - Minagawa, Tomohiro AU - Minagawa T AD - Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. FAU - Horio, Yuki AU - Horio Y AUID- ORCID: 0000-0001-9760-0173 AD - Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. FAU - Kuwahara, Ryuichi AU - Kuwahara R AD - Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. FAU - Nakamura, Shiro AU - Nakamura S AD - Department of Internal Medicine II, Osaka Medical College Hospital, Osaka, Japan. FAU - Watanabe, Kenji AU - Watanabe K AUID- ORCID: 0000-0002-3781-4724 AD - Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. FAU - Saruta, Masayuki AU - Saruta M AD - Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. FAU - Fujii, Toshimitsu AU - Fujii T AD - Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan. FAU - Kobayashi, Taku AU - Kobayashi T AD - Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan. FAU - Sugimoto, Ken AU - Sugimoto K AD - First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. FAU - Hirai, Fumihito AU - Hirai F AUID- ORCID: 0000-0002-5493-5675 AD - Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. FAU - Esaki, Motohiro AU - Esaki M AD - Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan. FAU - Hiraoka, Sakiko AU - Hiraoka S AUID- ORCID: 0000-0002-9796-6930 AD - Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan. FAU - Matsuoka, Katsuyoshi AU - Matsuoka K AD - Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan. FAU - Shinzaki, Shinichiro AU - Shinzaki S AD - Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Matsuura, Minoru AU - Matsuura M AD - Department of Gastroenterology and Hepatology, School of Medicine, Kyorin University, Tokyo, Japan. FAU - Inoue, Nagamu AU - Inoue N AD - Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan. FAU - Nakase, Hiroshi AU - Nakase H AD - Department of Gastroenterology and Hepatology, School of Medicine, Sapporo Medical University, Sapporo, Japan. FAU - Watanabe, Mamoru AU - Watanabe M AD - Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan. LA - eng GR - Japanese Society of Gastroenterology/ PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20201014 PL - Australia TA - J Gastroenterol Hepatol JT - Journal of gastroenterology and hepatology JID - 8607909 RN - 0 (Gastrointestinal Agents) RN - 0 (Tumor Necrosis Factor-alpha) SB - IM MH - Crohn Disease/*surgery MH - Female MH - Gastrointestinal Agents/pharmacology/*therapeutic use MH - Humans MH - Male MH - Postoperative Period MH - Recurrence MH - Secondary Prevention/*methods MH - Time Factors MH - Treatment Outcome MH - Tumor Necrosis Factor-alpha/*antagonists & inhibitors OTO - NOTNLM OT - Adverse events OT - Anti-tumor necrosis factor alpha therapy OT - Clinical recurrence OT - Crohn's disease OT - Endoscopic recurrence EDAT- 2020/10/02 06:00 MHDA- 2021/09/25 06:00 CRDT- 2020/10/01 17:17 PHST- 2020/09/04 00:00 [revised] PHST- 2020/07/21 00:00 [received] PHST- 2020/09/25 00:00 [accepted] PHST- 2020/10/02 06:00 [pubmed] PHST- 2021/09/25 06:00 [medline] PHST- 2020/10/01 17:17 [entrez] AID - 10.1111/jgh.15288 [doi] PST - ppublish SO - J Gastroenterol Hepatol. 2021 Apr;36(4):864-872. doi: 10.1111/jgh.15288. Epub 2020 Oct 14.