Induction Treatment with Anti-TNF Decreases C-Reactive Protein Levels among Crohnʼs Disease Patients: A Systematic Review and Meta-analysis
Notice bibliographique
Résumé
Purpose: C-reactive protein (CRP) is a non-specific marker of inflammation and is used in the monitoring of patients with Crohn's disease (CD). Among CD patients, CRP levels are associated with disease activity and are correlated with endoscopic remission. We conducted a systematic review and meta-analysis to quantify changes in CRP following induction therapy with an anti-TNF agent in CD patients. Methods: MEDLINE, EMBASE, and Cochrane CENTRAL were searched to identify randomized placebo-controlled trials (RCTs) of any anti-TNF agent (adalimumab, infliximab, or certolizumab) used to treat CD. Eligible studies included data on CRP levels at baseline and at any point following induction treatment. Studies reporting both a measure of effect (mean or median) and a corresponding measure of variability at both baseline and follow-up were included in a meta-analysis using a random effects model. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated to quantify the drop in CRP following induction treatment. Differences were calculated separately for all trial participants receiving an anti-TNF, and for those receiving placebo. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. Results: Six RCTs of anti-TNF therapy in CD reported CRP data following induction treatment (one adalimumab, two infliximab, and three certolizumab). Decreases in CRP levels following induction treatment were observed in the treatment arms of all identified trials. In contrast, decreases in CRP among patients receiving placebo were not observed. Two of the trials (both infliximab) provided sufficient data to pool in a meta-analysis. Patients receiving infliximab experienced a significant decrease in CRP concentration (WMD = -1.59; 95% CI -2.25, -0.94). CRP concentrations among patients receiving placebo did not significantly change during the induction period (WMD = 0.17; 95% CI -0.64, 0.98). Significant heterogeneity was not observed for either the treatment (p = 0.300; I2 = 6.9%) or placebo trial arms (p = 0.899; I2 = 0.0%). Conclusion: Induction therapy with an anti-TNF is effective in decreasing CRP concentrations among Crohn's disease patients. CRP may be an effective non-invasive indicator of patients' initial responses to anti-TNF therapy. Disclosure - EK, IAV, YL, SH: None. RP: speaker, a consultant and an advisory board member for Abbott Laboratories, Merck, Schering-Plough, Shire, Centocor, Elan Pharmaceuticals, and Procter and Gamble; consultant and speaker for Astra Zeneca; consultant and an advisory board member for Ferring and UCB; consultant for Glaxo-Smith Kline and Bristol Meyers Squibb; speaker for Byk Solvay, Axcan, Jansen, and Prometheus; research funding from Merck, Schering-Plough, Abbott Laboratories, Elan Pharmaceuticals, Procter and Gamble, Bristol Meyers Squibb, and Millennium Pharmaceuticals; educational support from Merck, Schering-Plough, Ferring, Axcan, and Jansen. CHS: speaker for Janssen Canada; participated in advisory board for Janssen Canada and Abbvie; received research support from Janssen Canada. SG: speaker for Merck, Schering-Plough, Centocor, Abbott, UCB Pharma, Pfizer, Ferring, and Procter and Gamble; participated in ad-hoc advisory board meetings for Centocor, Abbott, Merck, Schering-Plough, Proctor and Gamble, Shire, UCB Pharma, Pfizer, and Millennium; research funding from Procter and Gamble, Merck, and Schering-Plough. GGK: speaker for Merck, Schering-Plough, Abbott, and UCB Pharma; participated in advisory board meetings for Abbott, Merck, Schering-Plough, Shire, and UCB Pharma; research support from Abbott and Shire.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,020 | 0,036 |
| Bibliométrie | 0,006 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».