The Comparative Effectiveness of Anti-TNF Therapy in Crohn's Disease: A Network Meta-Analysis of Indirect Comparisons.
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 ... read morein the 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
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