title: Tumor necrosis factor-α antibodies (infliximab, adalimumab and certolizumab) in Crohn's disease: systematic review and meta-analysis.
abstract: BACKGROUND
  This meta-analysis compares the effectiveness and safety of tumor necrosis factor α (TNF-α) antibodies (infliximab, adalimumab and certolizumab) with either a placebo or each of them in the treatment of Crohn's disease (CD).
  
  
  METHODS
  A systematic review of literature published up to November 2012 was performed and a meta-analysis of identified studies was carried out. We searched the following databases: PubMed, EMBASE, The Cochrane Library and others. Only randomized or clinical controlled trials were included.
  
  
  RESULTS
  Nineteen clinical trials fulfilled the established criteria (5 studies for infliximab vs. placebo, 6 for each adalimumab or certolizumab vs. placebo and 2 comparing infliximab with adalimumab). The results of meta-analysis showed that anti-TNF therapy in patients with CD is safe and statistically significantly more effective when compared with the placebo for induction of remission at week 4 (RB = 1.90, 95% CI: 1.55-2.33, p < 0.00001), maintenance of remission at weeks 20-30 (RB = 1.86, 95% CI: 1.61-2.15, p < 0.00001) and at weeks 48-56 (RB = 2.75, 95% CI: 2.13-3.54, p < 0.00001) in patients who responded to the induction therapy and patients randomized before the induction. Anti-TNF agents were also superior to the placebo in fistula healing (during short-term induction, as well as long-term maintenance) and inducing CR-70 but not CR-100 at week 4. Moreover, the anti-TNF therapy had a significant effect on achieving both CR-70 and CR-100 during long-term maintenance.
  
  
  CONCLUSIONS
  Infliximab, adalimumab and certolizumab are effective as both induction and maintenance therapy in moderate to severe Crohn's disease in adults, including patients with fistulas. The safety profile was acceptable.
authors.affiliation: Institute of Public Health, Collegium Medicum , Jagiellonian University, Cracow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kawalec
authors.forename: Alicja
authors.initials: A
authors.lastname: Mikrut
authors.forename: Natalia
authors.initials: N
authors.lastname: Wiśniewska
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pilc
keywords: Crohn's disease; meta-analysis; systematic review; tumor necrosis factor-α antibodies