체계적 문헌고찰 및 메타분석: 크론병 환자에서 Infliximab과 Adalimumab의 유효성 비교
Systematic Review with Meta-Analysis: Comparative Effectiveness of Infliximab versus Adalimumab in Patients with Crohn’s Disease
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Objectives: Infliximab and adalimumab are common biologic agents to induce remission state among patients with Crohn’s disease. Although, direct head-to-head studies comparing the clinical outcomes of the two treatments are sparse, several observational trials have been conducted recently. In this study, we performed systematic literature review and meta-analysis of cohort studies to compare the effectiveness of infliximab and adalimumab. Methods: We searched four databases, Ovid-Medline, Embase, PubMED, and Cochran Library. Observational studies comparing infliximab and adalimumab in patients with Crohn’s disease were selected. Quality of studies was assessed, and meta-analysis was conducted using a random effect model. In addition, subgroup analyses were performed based on the diagnostic criteria, biologics naïve/relapse and patients’ ethnicity. Results: Of the total 2,209 searched studies, 8 studies were included in the analysis. No significant difference in clinical remission between Infliximab and adalimumab was found [risk ratio (RR) 0.98, 95% confidence interval (CI) 0.90−1.07, heterogeneity: p=0.08, I2=45%]. In subgroup analysis, we found that the effectiveness of adalimumab was significantly better than infliximab (RR 0.77, 95% CI 0.61−0.98) in Asian population, however, due to the insufficient number of included studies for Asian population, careful interpretation is needed. Conclusion: The effectiveness of infliximab and adalimumab is comparable in observational studies. Follow-up studies are needed to find out treatment outcomes in different ethnicity.
Abstract
Objectives: Infliximab and adalimumab are common biologic agents to induce remission state among patients with Crohn’s disease. Although, direct head-to-head studies comparing the clinical outcomes of the two treatments are sparse, several observational trials have been conducted recently. In this study, we performed systematic literature review and meta-analysis of cohort studies to compare the effectiveness of infliximab and adalimumab. Methods: We searched four databases, Ovid-Medline, Embase, PubMED, and Cochran Library. Observational studies comparing infliximab and adalimumab in patients with Crohn’s disease were selected. Quality of studies was assessed, and meta-analysis was conducted using a random effect model. In addition, subgroup analyses were performed based on the diagnostic criteria, biologics naïve/relapse and patients’ ethnicity. Results: Of the total 2,209 searched studies, 8 studies were included in the analysis. No significant difference in clinical remission between Infliximab and adalimumab was found [risk ratio (RR) 0.98, 95% confidence interval (CI) 0.90−1.07, heterogeneity: p=0.08, I2=45%]. In subgroup analysis, we found that the effectiveness of adalimumab was significantly better than infliximab (RR 0.77, 95% CI 0.61−0.98) in Asian population, however, due to the insufficient number of included studies for Asian population, careful interpretation is needed. Conclusion: The effectiveness of infliximab and adalimumab is comparable in observational studies. Follow-up studies are needed to find out treatment outcomes in different ethnicity.
참고문헌 (16)
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