The Comparative Effectiveness of Anti-TNF Therapy in Crohn's Disease: A Network Meta-Analysis of Indirect Comparisons.
Tobar, Annette.
2011
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Abstract: Background: Although placebo-controlled trials for the treatment of patients with moderate-to-severe Crohn's disease have found multiple anti-tumor necrosis factor therapies to be efficacious for achieving response and remission, no head-to-head comparisons between these biological agents exist. Objective: To compare the efficacy of the different anti-TNF medications with each other in t... read morehe treatment of moderate-to-severe Crohn's disease. Methods: We performed a systematic search of MEDLINE from inception to January 2011 for trials investigating anti-TNF therapy in adults with moderate-to-severe Crohn's disease. The primary outcome measures were response to therapy and disease remission. We calculated odds ratios of each biologic agent versus standard care using random effects meta-analysis and then performed indirect comparisons to evaluate the relative efficacy of active treatments. Results: We identified sixteen randomized, controlled trials with 4184 patients (2598 treated/1586 controls) including adalimumab, CDP571, certolizumab pegol, etanercept, infliximab and onercept. When compared indirectly, adalimumab-treated patients had a higher likelihood of achieving a clinical response versus patients treated with CDP571 (OR 2.50, 95% CI 1.26-4.97) and certolizumab pegol (OR 1.83, 95% CI 0.99-3.39). Infliximab was also superior to CDP571 (OR 5.46, 95% CI 2.00-14.85) and certolizumab pegol (3.99 95% CI 1.54-10.37) in inducing a clinically significant response. Adalimumab alone was superior to certolizumab pegol in maintaining a remissive state for at least 6 months (OR 2.09, 95% CI 1.12-3.91). Conclusions: In patients with moderate-to-severe Crohn's disease, indirect meta-analysis suggests that adalimumab and infliximab increase the odds of response compared with CDP571 and certolizumab pegol, and adalimumab improves the odds of maintaining remission compared with certolizumab pegol. Head-to-head trials with long-term follow-up should be performed.
Thesis (M.S.)--Tufts University, 2011.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: John Wong.
Committee: Christopher Schmid, and Thomas Trikalinos.
Keywords: Medicine, and Biostatistics.read less - ID:
- nv935d76d
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