Infliximab Reduces Hospitalizations and Surgery Interventions in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Infliximab Reduces Hospitalizations and Surgery Interventions in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
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DOI：
10.1097/mib.0b013e31829936c2
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发表时间：
2013-09-01
影响因子：
4.9
通讯作者：
Vaz-Carneiro, Antonio
中科院分区：
文献类型：
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作者：
Costa, Joao;Magro, Fernando;Vaz-Carneiro, Antonio
背景：我们系统地回顾了英夫利昔单抗在减少炎症性肠病(IBD)患者住院率和/或大手术率方面的益处。方法：通过2012年5月的文献检索，确定所有评价英夫利昔单抗治疗炎症性肠病患者的研究(实验性和观察性)，并提供住院和/或大手术率的数据。三位评价者独立完成了研究的选择、质量评估和数据提取。根据研究设计(随机临床试验和观察性研究)和IBD类型(克罗恩病[CD]和溃疡性结肠炎[UC])进行分析。随机效应荟萃分析用于得出合并和95%可信区间(CI)估计的优势比(OR)。结果：纳入27篇符合条件的研究(9篇随机对照试验和18篇观察性研究)。英夫利昔单抗降低了合并随机对照试验的住院风险(OR，0.51；95%CI 0.40-0.65；I-2=0%)和观察性研究结果(OR，0.29，95%CI，0.19-0.43；I-2=87%)，CD和UC之间没有差异。英夫利昔单抗降低了合并RCT结果中的手术风险，在CD(OR，0.31；95%CI，0.15-0.64；I-2=0%)和UC(OR，0.57；95%CI，0.37-0.88；I-2=0%)中都是如此。观察性研究的合并估计支持英夫利昔单抗用于CD患者(OR，0.32；95%CI，0.21-0.49；I-2=77%)，但不适用于UC患者。结论：现有的最好证据表明，英夫利昔单抗可降低IBD患者的住院风险和大手术需求。这种影响在临床上和经济上都是相关的，因为住院和手术被认为是疾病严重程度的标志，并大大增加了与IBD相关的总直接成本。
Background:We systematically reviewed infliximab benefit in reducing hospitalizations and/or major surgery rates in patients with inflammatory bowel disease (IBD).Methods:A literature search to May 2012 was performed to identify all studies (experimental and observational) evaluating patients with IBD treated with infliximab and providing data on hospitalizations and/or major surgery rates. Three reviewers independently performed studies' selection, quality assessment, and data extraction. Analyses were carried according to study design (randomized clinical trials [RCTs] and observational studies) and IBD type (Crohn's disease [CD] and ulcerative colitis [UC]). Random-effects meta-analysis was used to derive pooled and 95% confidence intervals (CIs) estimates of odds ratios (OR). Heterogeneity was assessed with I-2 test.Results:Twenty-seven eligible studies were included (9 RCTs and 18 observational studies). Infliximab reduced hospitalization risk, both in pooled RCTs (OR, 0.51; 95% CI 0.40-0.65; I-2 = 0%) and results of observational studies (OR, 0.29, 95% CI, 0.19-0.43; I-2 = 87%), without differences between CD and UC. Infliximab reduced surgery risk in pooled RCTs results, both in CD (OR, 0.31; 95% CI, 0.15-0.64; I-2 = 0%) and UC (OR, 0.57; 95% CI, 0.37-0.88; I-2 = 0%). Pooled estimate from observational studies favored infliximab for patients with CD (OR, 0.32; 95% CI, 0.21-0.49; I-2 = 77%), but not for patients with UC.Conclusions:The best evidence available points toward a reduction of the risk of hospitalization and major surgery requirement in patients with IBD treated with infliximab. This impact is clinically and economically relevant because hospitalization and surgery are considered to be markers of disease severity and significantly contribute to the total direct costs associated with IBD.