Premium
Concomitant use of an immunomodulator with ustekinumab as an induction therapy for Crohn's disease: A systematic review and meta‐analysis
Author(s) -
Yoshihara Takeo,
Shinzaki Shinichiro,
Amano Takahiro,
Iijima Hideki,
Takehara Tetsuo,
Inoue Nagamu,
Uchino Motoi,
Esaki Motohiro,
Kobayashi Taku,
Saruta Masayuki,
Sugimoto Ken,
Nakamura Shiro,
Hata Keisuke,
Hirai Fumihito,
Hiraoka Sakiko,
Fujii Toshimitsu,
Matsuura Minoru,
Matsuoka Katsuyoshi,
Watanabe Kenji,
Nakase Hiroshi,
Watanabe Mamoru
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15401
Subject(s) - medicine , ustekinumab , concomitant , meta analysis , odds ratio , crohn's disease , confidence interval , adverse effect , randomized controlled trial , cochrane library , medline , combination therapy , surgery , disease , adalimumab , political science , law
Background and aim Ustekinumab (UST), a fully humanized monoclonal antibody against the p40 subunit of interleukin‐12/23, is effective for the treatment of Crohn's disease (CD). The benefit of concomitant use of an immunomodulator (IM) with UST, however, is unclear. This study aimed to provide a systematic review and meta‐analysis comparing the efficacy and safety of concomitant use of an IM with UST as an induction therapy for CD patients. Methods A systematic literature search was performed using PubMed/MEDLINE, the Cochrane Library, and the Japana Centra Revuo Medicina from inception to October 31, 2019. The main outcome measure was achievement of clinical efficacy (remission, response, and clinical benefit) at 6–12 weeks. The quality of the included studies was assessed using the risk of bias in non‐randomized studies of interventions (ROBINS‐I) tools. The fixed‐effects model was used to calculate the pooled odds ratios. Results From 189 yielded articles, six including a total of 1507 patients were considered in this meta‐analysis. Concomitant use of an IM with UST was significantly effective than UST monotherapy as an induction therapy (pooled odds ratio in the fixed‐effects model: 1.35, 95% confidence interval [1.06–1.71], P = 0.015). The heterogeneity among studies was low ( I 2 = 2.6%). No statistical comparisons of the occurrence of adverse events between UST monotherapy and concomitant use of an IM with UST were performed. Conclusion The efficacy of concomitant use of an IM with UST as an induction therapy for CD was significantly superior to that of monotherapy with UST.