SynthesisGastroenterology2015
Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn's disease after surgery: a systematic review and network meta-analysis.
Synthesis in Gastroenterology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
41 citing papers in PubMed, 3 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- ACG Clinical Guideline: Management of Crohn's Disease in Adults.The American journal of gastroenterology · 2018Guideline
- A Meta-Analysis of Efficacy and Safety of Infliximab for Prevention of Postoperative Recurrence in Patients with Crohn's Disease.BioMed research international · 2018Pooled it
- Systematic review with meta-analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy.Alimentary pharmacology & therapeutics · 2017Pooled it
- Mercaptopurine versus placebo to prevent recurrence of Crohn's disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial.The lancet. Gastroenterology & hepatology · 2016Trial
- Mechanisms of Inflammation in Post-Operative Recurrence of Crohn's Disease.Journal of inflammation research · 2026Review
- Postoperative Recurrence in Crohn's Disease: Pathophysiology, Risk Stratification, and Management Strategies.Journal of clinical medicine · 2025Review
- Clinical Predictors of Early and Late Endoscopic Recurrence Following Ileocolonic Resection in Crohn's Disease.Journal of Crohn's & colitis · 2024Article
- A real-world disproportionality analysis of mesalazine data mining of the public version of FDA adverse event reporting system.Frontiers in pharmacology · 2024Article
- Impact of timing of primary ileocecal resection on prognosis in patients with Crohn's disease.BJS open · 2023Article
- Korean clinical practice guidelines on biologics for moderate to severe Crohn's disease.Intestinal research · 2023Review
- Gastrointestinal dysbiosis and Escherichia coli pathobionts in inflammatory bowel diseases.APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2022Article
- Apheresis: A cell-based therapeutic tool for the inflammatory bowel disease.World journal of clinical cases · 2022Review
- Factors associated with anti-tumor necrosis factor effectiveness to prevent postoperative recurrence in Crohn's disease.Intestinal research · 2022Article
- Use of thiopurines in inflammatory bowel disease: an update.Intestinal research · 2022Review
- Capsule Endoscopy Is Useful for Postoperative Tight Control Management in Patients with Crohn's Disease.Digestive diseases and sciences · 2022Article
- AGA Technical Review on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn's Disease.Gastroenterology · 2021Review
- First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases: A 2020 Delphi consensus.World journal of gastroenterology · 2020Article
- Real-world cost-effectiveness associated with infliximab maintenance therapy for moderate to severe Crohn's disease in China.World journal of gastroenterology · 2020Article
- Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events.JAMA neurology · 2020Article
- Network Meta-Analyses in Inflammatory Bowel Disease.Gastroenterology & hepatology · 2020Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsThere are several drugs that might decrease the risk of relapse of Crohn's disease (CD) after surgery, but it is unclear whether one is superior to others. We estimated the comparative efficacy of different pharmacologic interventions for postoperative prophylaxis of CD, through a network meta-analysis of randomized controlled trials.
methodsWe conducted a systematic search of the literature through March 2014. We identified randomized controlled trials that compared the abilities of mesalamine, antibiotics, budesonide, immunomodulators, anti-tumor necrosis factor α (anti-TNF) (started within 3 months of surgery), and/or placebo or no intervention to prevent clinical and/or endoscopic relapse of CD in adults after surgical resection. We used Bayesian network meta-analysis to combine direct and indirect evidence and estimate the relative effects of treatment.
resultsWe identified 21 trials comprising 2006 participants comparing 7 treatment strategies. In a network meta-analysis, compared with placebo, mesalamine (relative risk [RR], 0.60; 95% credible interval [CrI], 0.37-0.88), antibiotics (RR, 0.26; 95% CrI, 0.08-0.61), immunomodulator monotherapy (RR, 0.36; 95% CrI, 0.17-0.63), immunomodulator with antibiotics (RR, 0.11; 95% CrI, 0.02-0.51), and anti-TNF monotherapy (RR, 0.04; 95% CrI, 0.00-0.14), but not budesonide (RR, 0.93; 95% CrI, 0.40-1.84), reduced the risk of clinical relapse. Likewise, compared with placebo, antibiotics (RR, 0.41; 95% CrI, 0.15-0.92), immunomodulator monotherapy (RR, 0.33; 95% CrI, 0.13-0.68), immunomodulator with antibiotics (RR, 0.16; 95% CrI, 0.04-0.48), and anti-TNF monotherapy (RR, 0.01; 95% CrI, 0.00-0.05), but neither mesalamine (RR, 0.67; 95% CrI, 0.39-1.08) nor budesonide (RR, 0.86; 95% CrI, 0.61-1.22), reduced the risk of endoscopic relapse. Anti-TNF monotherapy was the most effective pharmacologic intervention for postoperative prophylaxis, with large effect sizes relative to all other strategies (clinical relapse: RR, 0.02-0.20; endoscopic relapse: RR, 0.005-0.04).
conclusionsBased on Bayesian network meta-analysis combining direct and indirect treatment comparisons, anti-TNF monotherapy appears to be the most effective strategy for postoperative prophylaxis for CD.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.