title: Prevention and treatment of postoperative Crohn's disease recurrence with anti-TNF therapy: a meta-analysis of controlled trials.
abstract: BACKGROUND
  The magnitude of the efficacy of anti-tumour necrosis factor (TNF) therapy in preventing and treating postoperative Crohn's disease recurrence has yet to be determined.
  
  
  METHODS
  We searched MEDLINE, the Cochrane Library, and EMBASE. The primary endpoints, and clinical and endoscopic recurrence, were analysed using the Mantel-Haenszel and DerSimonian and Laird methods.
  
  
  RESULTS
  Nine controlled trials (n=362) that evaluated the efficacy of anti-TNF therapy in preventing (n=7) or treating (n=2) postoperative recurrence were included. Anti-TNF therapy was more effective at preventing (n=6) endoscopic recurrence than the control arms (odds ratio 0.05; 95% confidence interval 0.02-0.13, P<0.0001; NNT=1.9). Anti-TNF therapy was more effective at preventing (n=5) clinical recurrence than the control arms (odds ratio 0.10; 95% confidence interval 0.05-0.21, P<0.0001; NNT=2.4). Anti-TNF therapy was more effective than control arms at treating endoscopic postoperative recurrence (n=2; odds ratio 16.64; 95% confidence interval 2.51-110.27, P<0.004; NNT=2.3). Neither heterogeneity nor publication bias was observed.
  
  
  CONCLUSIONS
  Anti-TNF agents may be more effective in preventing clinical and endoscopic postoperative Crohn's disease recurrence than control treatment (thiopurines or mesalamine). Efficacy in treating postoperative Crohn's disease recurrence will require further investigation. Large randomised controlled trials are awaited.
authors.affiliation: Department of Immunology, Saint-Etienne University Hospital, France.
authors.forename: Amelie
authors.initials: A
authors.lastname: Carla-Moreau
authors.affiliation: Department of Immunology, Saint-Etienne University Hospital, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Gastroenterology, Saint-Etienne University Hospital, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
authors.affiliation: Department of Immunology, Saint-Etienne University Hospital, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Genin
authors.affiliation: Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Lorraine University, France. Electronic address: peyrinbiroulet@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015122:Mercaptopurine / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use; D064887:Observational Studies as Topic; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012074:Remission Induction; D055502:Secondary Prevention; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine; D015122:Mercaptopurine
keywords: Anti-TNF; Crohn's disease; Postoperative recurrence; Prevention; Treatment