John K. Marshall, MD, MSc, FRCPC, AGAF
Which interventions are effective for maintaining remission in Crohn disease?
Studies selected evaluated interventions for maintaining remission in Crohn disease. Outcome was maintenance of remission (or relapse).
MEDLINE (1966 to May 2007) and Cochrane Library (Issue 2, 2007) were searched for randomized controlled trials (RCTs) or systematic reviews or meta-analyses of RCTs; then Cochrane Inflammatory Bowel Disease Group was contacted. 8 interventions (azathioprine, 5-aminosalicylates, corticosteroids, budesonide, antimycobacterial agents, probiotics, omega-3 fatty acids, and enteral nutrition) were evaluated in systematic reviews, and 6 interventions (methotrexate, infliximab, adalimumab, natalizumab, certolizumab, and cyclosporine) were evaluated in RCTs.
Meta-analysis showed that azathioprine and omega-3 fatty acids were more effective than placebo for maintaining remission (Table). Single studies showed that methotrexate, infliximab, adalimumab, natalizumab, and certolizumab were more effective than placebo and enteral nutrition was more effective than no supplementation for maintaining remission (Table). 5-aminosalicylates, corticosteroids, budesonide, cyclosporine, antimycobacterials, and probiotics did not differ from placebo for maintaining remission at 6 to 24 months.
Azathioprine, methotrexate, infliximab, certolizumab, adalimumab, natalizumab, enteral nutrition, and omega-3 fatty acids are effective for maintaining remission in Crohn disease.
Comparisons of various drugs vs placebo in Crohn disease*
*Abbreviations defined in Glossary. Weighted event rates, RBI, RRR, NNT, and CI calculated from control event rates and relative risks in article. Analyses based on a fixed-effects model.
†Weighted event rates, RBI, RRR, NNT, and CI calculated from control event rates and odds ratios in article.
‡Compared with no supplementation.
§NNT provided in article.
John K. Marshall. Review: Azathioprine, infliximab, certolizumab, and adalimumab are effective for maintaining remission in Crohn disease. Ann Intern Med. 2008;148:JC4–9. doi: 10.7326/0003-4819-148-12-200806170-02009
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Published: Ann Intern Med. 2008;148(12):JC4-9.
Gastroenterology/Hepatology, Inflammatory Bowel Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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