title: Efficacy of tumour necrosis factor antagonists on remission, colectomy and hospitalisations in ulcerative colitis: Meta-analysis of placebo-controlled trials.
abstract: BACKGROUND
  The potential for disease modification of tumour necrosis factor antagonists in ulcerative colitis remains debated.
  
  
  METHODS
  We searched MEDLINE, the Cochrane Library and EMBASE. Clinical response/remission, mucosal healing, colectomy, disease-related hospitalisations, and adverse events were analysed by the methods of Peto and Der Simonian and Laird.
  
  
  RESULTS
  Five trials enrolled 3654 patients (anti-tumour necrosis factor=2338). Anti-tumour necrosis factor therapy was more effective than placebo to induce and maintain clinical remission, with a number needed to treat of 12 (95% confidence interval [CI], 7-35) and 6 (95% CI, 4-12) for adalimumab and infliximab, respectively. Anti-tumour necrosis factor therapy was more effective than placebo to induce and maintain mucosal healing, with number needed to treat of 9 (95% CI, 5-48), 7 (95% CI, 5-17), 4 (95% CI, 3-6) for adalimumab, golimumab and infliximab, respectively. Only infliximab was associated with a reduced need for colectomy. Both infliximab and adalimumab were associated with less hospitalisations. Anti-tumour necrosis factor therapy did not increase the risk of adverse events.
  
  
  CONCLUSIONS
  Anti-tumour necrosis factor therapy is more effective than placebo to induce and maintain clinical remission and mucosal healing. Both infliximab and adalimumab are associated with less hospitalisations. Infliximab reduces the need for colectomy. Anti-tumour necrosis factor therapy does not increase the risk of adverse events.
authors: Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
authors: Anthony
authors: A
authors: Lopez
authors: Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
authors: Alexander C
authors: AC
authors: Ford
authors: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA.
authors: Jean-Frédéric
authors: JF
authors: Colombel
authors: Clinic Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors: Walter
authors: W
authors: Reinisch
authors: Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.
authors: William J
authors: WJ
authors: Sandborn
authors: Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France. Electronic address: peyrinbiroulet@gmail.com.
authors: Laurent
authors: L
authors: Peyrin-Biroulet
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D010919:Placebos / Q000008:administration & dosage; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Adalimumab; Golimumab; Infliximab; Ulcerative colitis