Anti-tumor necrosis factor-alpha agents (anti-TNF) are effective therapies for the treatment of Crohn's disease (CD), but their comparative efficacy is unknown.
Dr Waljee and colleagues from Michigan performed a network meta-analysis comparing the efficacy of anti-TNF therapies in CD.
After screening 506 studies, reviewers extracted information on 10 studies.
Traditional meta-analysis was used to compare each anti-TNF agent to placebo.
Bayesian network meta-analysis was performed to compare the effects of anti-TNF agents to placebo.
In addition, sample sizes for comparative efficacy trials were calculated.
|Adalimumab is superior to certolizumab pegol for induction of remission|
|Alimentary Pharmacology & Therapeutics|
Compared to placebo, TMA revealed that anti-TNF agents result in a higher likelihood of induction of remission and response as well as maintenance of remission and response.
Using network meta-analysis, the team found nonsignificant trends between infliximab and adalimumab or certolizumab pegol.
Among subcutaneous therapies, using network meta-analysis, the researchers demonstrated superiority of adalimumab to certolizumab pegol for induction of remission.
Sample size calculations suggest that adequately powered head-to-head comparative efficacy trials would require greater than 3000 patients.
Dr Waljee's team concludes, "All anti-TNF agents are effective for induction and maintenance of response and remission in the treatment of CD."
"Although adalimumab is superior to certolizumab pegol for induction of remission, there is no evidence of clinical superiority among anti-TNF agents."
"Head-to-head trials among the anti-TNF agents are impractical in terms of size and cost."