title: Antitumor necrosis factor α is more effective than conventional medical therapy for the prevention of postoperative recurrence of Crohn's disease: a meta-analysis.
abstract: BACKGROUND
  There have seen several studies evaluating the efficacy of anti-tumor necrosis factor α (anti-TNFα) compared with conventional therapy (i.e. immunomodulators, mesalamine, or placebo) at preventing postoperative Crohn's disease (CD) recurrence. The results of these studies have been variable and the magnitude by which anti-TNFα therapy alters the natural history of CD in the postoperative setting has not yet been fully defined.
  
  
  METHODS
  A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (May 2014). All studies on adult patients with CD that compared anti-TNFα therapy versus conventional therapy or placebo to prevent CD recurrence were included. Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess for clinical remission.
  
  
  RESULTS
  In the pooled analysis, there was a higher frequency of achieving clinical remission beyond 1 year from time of surgery among patients receiving anti-TNFα therapy compared with conventional therapy [OR 6.41; 95% confidence interval (CI) 2.88-14.27]. There was also a significantly higher rate of achieving both endoscopic (OR 26.44; 95% CI 10.48-66.68) and histologic remission (OR 9.80; 95% CI 2.54-37.81) in the anti-TNFα therapy group compared with the conventional therapy group.
  
  
  CONCLUSIONS
  Anti-TNFα therapy is more effective at preventing clinical, endoscopic, and histologic recurrence of CD beyond 1 year from time of surgery compared with conventional therapy.
authors.affiliation: aDepartment of Medicine bDepartment of Pharmacy, University of California, Irvine cDivision of Gastroenterology, Long Beach VA Healthcare Systems, Long Beach, California dDepartment of Medicine, University of Missouri, Columbia, Missouri, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.forename: Pejman
authors.initials: P
authors.lastname: Solaimani
authors.forename: Emily T
authors.initials: ET
authors.lastname: Nguyen
authors.forename: Mohammad Mazen
authors.initials: MM
authors.lastname: Jamal
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D016017:Odds Ratio; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha