Comparative Efficacy of Anti-tumor Necrosis Factor (TNF) Therapy in Inducing and Maintaining Remission from Crohn's Disease: A Systematic Review and Meta-analysis

Abstract

Background: Anti-TNF agents have emerged not only as inducers of remission but have also shown clinical efficacy in the maintenance of remission in patients suffering from Inflammatory Bowel Disease. However, there is limited quantitative evidence of their effectiveness in Crohn’s Disease. Aim: The current study aims to investigate the relative efficacy of anti-TNF agents in inducing and maintaining remission in Crohn’s Disease, by systematically evaluating efficacy outcomes, such as CDAI, SES-CD, and TEAEs. Methods: A number of digital databases were searched to retrieve relevant literature. This included PubMed, Google Scholar, Cochrane, ClinicalTrials.gov. The PICOS framework was used to systematically select the data. We used the PRISMA framework to synthesize and report the relevant data. Results: A total of 10 randomized control trials were included in the final sample. Among the anti-TNF agents, adalimumab and infliximab were most frequently used for disease control. Anti-TNF drugs were positively associated with clinical remission OR= 1.31 (95% CI (0.69, 2.10)), p<0.02; improved SES-CD scores (>50% reduction in endoscopic lesions), 1.65 (95% CI (1.44, 1.87)), p<0.0001; sustained CD remission significantly, -25.65 (95% CI (-33.22, -18.07)), p<0.001; and showed a relatively insignificant impact in lowering the incidence of treatment-emergent adverse effects  0.84 (95% CI (0.69, 1.03)), p=0.10. Conclusion: Infliximab and adalimumab should be taken into consideration as first-line alternatives for maintaining remission in Crohn's disease due to their better efficacy and set-up safety profiles.