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International Journal of Colorectal Disease

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01-05-2009 | Original Article

Meta-analysis of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn’s disease (CD)

Authors: Yunfei Cao, Feng Gao, Cun Liao, Aihua Tan, Zengnan Mo

Published in: International Journal of Colorectal Disease | Issue 5/2009

Abstract

Introduction

We performed a meta-analysis to compare the clinical and endoscopic recurrence of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn’s disease.

Materials and methods

Trials were located through Medline, Embase, the Cochrane Central Register of Controlled Trials, Ovid, Sciencedirect, and Ingenta electronic databases. From 124 articles screened, 14 were identified as randomized placebo-controlled trials and were included for data extraction. Main outcome measures were clinical recurrence, endoscopic recurrence, and severe endoscopic recurrence. The meta-analysis was performed with the fixed-effects model.

Result

Fourteen studies with 1,497 participants were analyzed. In the intention-to-treat analysis, medical treatment was associated with a significantly lower incidence of clinical recurrence (relative risk of 0.74, 95% confidence interval 0.64–0.87, P = 0.000], but there were no significant differences in endoscopic recurrence (0.94, 0.83–1.07, P = 0.353) and severe endoscopic recurrence (0.83, 0.60–1.16, P = 0.281) between the two groups. When using per-protocol analysis, the results is similar, medical treatment was associated with a significantly lower incidence of clinical recurrence (0.84, 0.72–0.97, P = 0.020), but there were no significant differences in endoscopic recurrence (0.94, 0.85–1.05, P = 0.268) or severe endoscopic recurrence (0.76, 0.55–1.04, P = 0.084) between the two groups of patients.

Conclusions

Medical treatment has a sufficiently beneficial effect on decreasing the risk of clinical postoperative recurrence in patients with CD.

Podolsky DK (2002) Inflammatory bowel disease. N Engl J Med 347:417–429PubMedCrossRef

Tamboli CP (2007) Current medical therapy for chronic inflammatory bowel diseases. Surg Clin North Am 87:697–725PubMedCrossRef

Fichera A, Michelassi F (2007) Surgical treatment of Crohn’s disease. J Gastrointest Surg 11:791–803PubMedCrossRef

Steele SR (2007) Operative management of Crohn’s disease of the colon including anorectal disease. Surg Clin North Am 87:611–631PubMedCrossRef

Terdiman JP (2008) Prevention of postoperative recurrence in Crohn’s disease. Clin Gastroenterol Hepatol 6:616–620 (Oct 27)PubMedCrossRef

Achkar JP, Hanauer SB (2000) Medical therapy to reduce postoperative Crohn’s disease recurrence. Am J Gastroenterol 95:1139–1146PubMedCrossRef

Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99:956–963PubMed

Penner RM, Madsen KL, Fedorak RN (2005) Postoperative Crohn’s disease. Inflamm Bowel Dis 11:765–777PubMedCrossRef

Froehlich F, Juillerat P, Felley C, Mottet C, Vader JP, Burnand B, Michetti P, Gonvers JJ (2005) Treatment of postoperative Crohn’s disease. Digestion 71:49–53PubMedCrossRef

10.

Hellers G, Cortot A, Jewell D, Leijonmarck CE, Lofberg R, Malchow H, Nilsson LG, Pallone F, Pena S, Persson T, Prantera C, Rutgeerts P (1999) Oral budesonide for prevention of postsurgical recurrence in Crohn’s disease. The IOIBD Budesonide Study Group. Gastroenterology 116:294–300PubMedCrossRef

11.

Lémann M (2006) Review article: can post-operative recurrence in Crohn’s disease be prevented? Aliment Pharmacol Ther 24(Suppl 3):22–28PubMedCrossRef

12.

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900PubMedCrossRef

13.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef

14.

Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989PubMed

15.

Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613PubMedCrossRef

16.

Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F (2000) Methods for meta-analysis in medical research. Wiley, Chichester

17.

Yusuf S, Peto R, Lewis J, Collins R, Sleight P (1985) Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 27:335–371PubMedCrossRef

18.

Egger M, Smith GD, Altman DG (2001) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Books, London

19.

Brignola C, Cottone M, Pera A, Ardizzone S, Scribano ML, De Franchis R, D’Arienzo A, D’Albasio G, Pennestri D (1995) Mesalamine in the prevention of endoscopic recurrence after intestinal resection for Crohn’s disease. Gastroenterology 108:345–349PubMedCrossRef

20.

Colombel J-F, Rutgeerts P, Malchow H, Jacyna M, Nielsen OH, Rask-Madsen J et al (2001) Interleukin 10 (Tenovil) in the prevention of postoperative recurrence of Crohn’s disease. Gut 49:42–46PubMedCrossRef

21.

Ewe K, Bottger T, Buhr HJ, Ecker KW, Otto HF (1999) Low-dose budesonide treatment for prevention of postoperative recurrence of Crohn’s disease: a multicentre randomized placebo-controlled trial. Eur J Gastroenterol Hepatol 11:277–282PubMedCrossRef

22.

Florent C, Cortot A, Quandale P, Sanhoud T, Modigliani R, Sarfaty E, Group d’Etudes Therapeutiques des AffectionsInflammatoires Digestives(GETAID) et al (1996) Placebo-controlled clinical trial of mesalazine in the prevention of early recurrence after resection for Crohn’s disease. Eur J Gastroenterol Hepatol 8:229–233PubMedCrossRef

23.

Hanauer SB, Korelitz BI, Rutgeerts P, Peppercorn MA, Thisted RA, Cohen RD, Present DH (2004) Post-operative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine or placebo: a 2-year trial. Gastroenterology 127:723–729PubMedCrossRef

24.

Hellers G, Cortot A, Jewell D et al (1999) Oral budesonide for prevention of postsurgical recurrence in Crohn’s disease. Gastroenterology 116:294–300PubMedCrossRef

25.

Lochs H, Mayer M, Fleig W, Mortensen PB, Bauer P, Genser D, Petritsch W, Raithel M, Hoffmann R, Gross V, Plauth M, Staun M, Nesje LB (2000) Prophylaxis of postoperative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s Disease Study VI. Gastroenterology 118:264–273PubMedCrossRef

26.

Marteau P, Lemann M, Seksik P et al (2005) Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn’s disease: a randomised, double-blind, placebo-controlled GETAID trial. Gut 23:23

27.

McLeod RS, Wolff BG, Steinhart AH, Carryer PW, O’Rourke K, Andrews DF, Blair JE, Cangemi JR, Cohen Z, Cullen JB, Chaytor RG, Greenberg GR, Jaffer NM, Jeejeebhoy KN, MacCarty RL, Ready RL, Weiland LH (1995) Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease. Gastroenterology 109:404–413PubMedCrossRef

28.

Prantera C, Scribano ML, Falasco G, Andreoli A, Luzi C (2002) Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG. Gut 51:405–409PubMedCrossRef

29.

Rutgeerts P, Hiele M, Geboes K et al (1995) Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology 108:1617–1621PubMedCrossRef

30.

Rutgeerts P, Van Assche G, Vermeire S et al (2005) Ornidazole for prophylaxis of postoperative Crohn’s disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology 128:856–861PubMedCrossRef

31.

Sutherland LR, Martin F, Bailey RJ, Fedorak RN, Poleski M, Dallaire C et al (1997) A randomized, placebo-controlled, double-blind trial of mesalamine in the maintenance of remission of Crohn’s disease. Gastroenterology 112:1069–1077PubMedCrossRef

32.

Van Gossum A, Dewit O, Louis E, de Hertogh G, Baert F, Fernand Fontaine P et al (2007) Multicenter randomized-controlled clinical trial of probiotics (Lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn’s disease after ileo-caecal resection. Inflamm Bowel Dis 13:135–142PubMedCrossRef

Title: Meta-analysis of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn’s disease (CD)
Authors: Yunfei Cao
Feng Gao
Cun Liao
Aihua Tan
Zengnan Mo
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 5/2009
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-009-0640-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Meta-analysis of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn’s disease (CD)

Abstract

Introduction

Materials and methods

Result

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Result

Conclusions

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