title: Biologics for the prevention of postoperative Crohn's disease recurrence: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of biologics in the prevention of postoperative recurrence of Crohn's disease.
  
  
  METHODS
  Published papers and conference literatures were screened for suitable studies. The main outcome measures were clinical, endoscopic recurrence and adverse events.
  
  
  RESULTS
  Seven controlled trials met the inclusion criteria for this meta-analysis. At one year postoperation, the biologic therapies showed significant preventative effects in clinical recurrence (RR=0.36, 95% CI: 0.16-0.79; P=0.01), endoscopic recurrence (RR=0.16, 95% CI: 0.07-0.34; P<0.01) and severe endoscopic recurrence (RR=0.17, 95% CI: 0.04-0.71; P=0.02) when compared with the control arms. Similarly, two years postresection, the use of biologics significantly reduced the risk of clinical, endoscopic and severe endoscopic recurrence relative to the controls. Although the biologic agents were not more effective than azathioprine in preventing clinical recurrence (P=0.14), they were more effective in preventing endoscopic recurrence (RR=0.09, 95% CI: 0.02-0.47; P<0.01). Moreover, administration of the biologics was not associated with any significant difference in the rate of adverse events (RR=1, 95% CI: 0.75-1.34; P=0.99) or severe adverse events (RR=1.03, 95% CI: 0.33-3.26; P=0.96) when compared with controls.
  
  
  CONCLUSIONS
  Biologics are superior to azathioprine and traditional therapies and are not associated with increased adverse events in the postoperative treatment of Crohn's disease.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province, Nanjing 210029, China.
authors.forename: Teng
authors.initials: T
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Yan-Fang
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: He
authors.affiliation: Department of Gastroenterology, Zhangjiagang First People's Hospital, Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou 215006, China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Ren
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Fang
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Jie-Wen
authors.initials: JW
authors.lastname: Su
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China.
authors.forename: Hong-Jie
authors.initials: HJ
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China; Department of Gastroenterology, Zhongda Hospital, Southeast University, Jiangsu Province, Nanjing 210000, China. Electronic address: ruihuashi@126.com.
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Shi
mesh_terms: D001688:Biological Products / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D003424:Crohn Disease / Q000188:drug therapy* / Q000517:prevention & control* / Q000601:surgery; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D011182:Postoperative Care; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D001688:Biological Products; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha