Biologics for the prevention of postoperative Crohn's disease recurrence: A systematic review and meta-analysis

Summary Aim 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. Conclusion Biologics are superior to azathioprine and traditional therapies and are not associated with increased adverse events in the postoperative treatment of Crohn's disease.