A96 ADALIMUMAB FOR MAINTENANCE OF REMISSION IN CROHN’S DISEASE

Maintenance of remission of Crohn’s disease (CD) is a clinically important goal, as disease relapse can negatively affect quality of life. The objective of this systematic review was to assess the efficacy and safety of adalimumab for maintenance of remission in patients with quiescent CD. EMBASE, MEDLINE, CENTRAL and the Cochrane IBD Group Specialized Register were searched from inception to April 2018. Randomized controlled trials (RCTs) comparing adalimumab to placebo or an active comparator were considered for inclusion. Data were analyzed on an intention-to-treat basis. Risk ratios (RR) and corresponding 95% confidence intervals (95% CI) were calculated for dichotomous outcomes. The primary outcome was the number of patients who relapsed. Secondary outcomes were failure to maintain clinical response, endoscopic remission, endoscopic response, histological remission and adverse events. Bias was assessed using the Cochrane risk of bias tool. GRADE was used to assess the overall quality of evidence supporting the primary outcome. Seven RCTs (n=1229) were included. Five trials were rated low risk of bias and two trials were rated as unclear risk of bias. Three studies comprising 683 patients included relapse at 52–56 weeks as an endpoint. Fifty-nine percent (252/430) of patients treated with adalimumab relapsed compared with 86% (217/253) of patients receiving placebo (RR 0.69, 95% CI 0.63–0.76, P<0.05; moderate quality evidence). Two RCTs (302 patients) reported the number of patients who failed to maintain clinical or endoscopic relapse at 52–56 weeks among those who received prior TNF antagonist therapy. Sixty-nine percent (129/186) of adalimumab patients relapsed compared with 93% (108/116) receiving placebo (RR 0.76, 95% CI 0.68–0.84, P<0.05; high quality evidence). Two RCTs including 562 patients included relapse at 24–26 weeks as an endpoint. Fifty-one percent (192/374) of patients who received adalimumab relapsed compared with 75% (149/188) of those who received placebo (RR 0.63, 95% CI 0.49–0.81, P<0.05; low quality evidence). Serious adverse events were seen in 8% (52/643) of patients who received adalimumab and 14% (53/368) of patients who received placebo (RR 0.55, 95% CI 0.38–0.79, P<0.05; low quality evidence) and withdrawal due to adverse events was reported in 7% (45/643) of adalimumab patients compared to 13% (48/369) of placebo patients (RR 0.57, 95% CI 0.39–0.83, P<0.05; low quality evidence) between the adalimumab and placebo groups. Adalimumab is an effective therapy to maintain clinical remission in patients with CD. It is also effective in patients who have previously been treated with TNF antagonists. Future research should continue to explore factors that influence initial and subsequent biologic selection for patients with moderate to severe CD. None

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.