Evidence map›Paper›PMID 28470787›Full record

ArticleAlimentary pharmacology & therapeutics2017

The benefit of combination therapy depends on disease phenotype and duration in Crohn's disease.

A N Ananthakrishnan, A Sakuraba, E L Barnes, J Pekow, L Raffals, M D Long, R S Sandler

Open access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Alimentary pharmacology & therapeutics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 12% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Observational
  5. Article
  6. Observational
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

A N AnanthakrishnanDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.ORCID 0000-0002-9436-1821
A SakurabaInflammatory Bowel Disease Center and Division of Gastroenterology, University of Chicago, Chicago, IL, USA.ORCID 0000-0003-2519-6129
E L BarnesDivision of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
J PekowInflammatory Bowel Disease Center and Division of Gastroenterology, University of Chicago, Chicago, IL, USA.
L RaffalsDivision of Gastroenterology, Mayo Clinic, Rochester, MN, USA.
M D LongDivision of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
R S SandlerCenter for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill · USUniversity of Chicago · USHarvard University · USMayo Clinic in Arizona · US

Funding

Pilot & Feasibility ProgramP30DK043351 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI RAYMOND T CHUNG · 1991 to 2026
$35.3M
PILOT AND FEASIBILITY STUDIESP30DK034987 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI ROBERT S. SANDLER · 1985 to 2026
$30.5M
Genetic predictors of anti-TNF treatment response and infections in IBDK23DK097142 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI ANANTHAKRISHNAN, ASHWIN N · 2012 to 2016
$846k
Novel microRNA regulatory networks predictive of colon carcinogenesis in IBDK08DK090152 · NIDDK · UNIVERSITY OF CHICAGO · PI PEKOW, JOEL · 2012 to 2016
$732k
Genetic predictors of calprotectin response with anti-TNF and anti-integrin therapy in inflammatory bowel diseasesR03DK112909 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI ANANTHAKRISHNAN, ASHWIN N · 2017 to 2018
$171k
NIDDK NIH HHS K08 DK090152NIDDK NIH HHS K23 DK097142NIDDK NIH HHS P30 DK034987NIDDK NIH HHS P30 DK043351NIDDK NIH HHS R03 DK112909
6 · The paper itself

Abstract

backgroundThe impact of combination therapy on disease-related morbidity in patients with established Crohn's disease (CD) or ulcerative colitis (UC) remains to be well-defined.

aimTo examine the effect of combination therapy on disease outcomes in CD and UC.

methodsUsing a multicenter prospective cohort, we classified CD and UC patients as being on monotherapy with anti-TNF or on combination with an immunomodulator. The primary outcome was a composite of new IBD-related surgery, hospitalisations, penetrating complications, need for corticosteroids or new biological at 1 year. Multivariable regression models adjusted for potential confounders.

resultsWe included 707 patients with CD (45% combination therapy) and 164 with UC (38% combination therapy). Combination therapy was not associated with reduction in the composite outcome in either CD (OR: 0.87, 95% CI: 0.63-1.22) or UC (OR: 1.45, 95% CI: 0.63-3.38). However, while no difference was noted in those with nonstricturing, nonpenetrating CD, a significant reduction in the likelihood of the outcome was seen in those with stricturing or penetrating CD (30% vs 39%, OR: 0.58, 95% CI: 0.37-0.90). A stronger effect was also observed in those with disease duration <5 years (OR: 0.35, 95% CI: 0.14-0.87) compared to those with a longer duration (OR: 0.75, 95% CI: 0.45-1.27). A similar reduction in occurrence of composite outcome was noted with infliximab and with other anti-TNF biologics.

conclusionThe benefit of combination immunomodulator-biological therapy is stronger in those with complicated Crohn's disease, particularly early on in their disease course.

Indexed as

AdultBiological ProductsColitis, UlcerativeCrohn DiseaseDisease ProgressionDrug Therapy, CombinationFemaleGastrointestinal AgentsHumansInflammatory Bowel DiseasesInfliximabMaleMiddle AgedPhenotypeProspective StudiesTime FactorsBiological ProductsGastrointestinal AgentsInfliximabTumor Necrosis Factor-alpha

Identifiers

PMID28470787
PMCPMC5484085
OpenAlexW2611412141

What OpenQuestion holds

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LicenceTDM
Read underepoch 390

Registered trials

None linked

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.