Evidence map›Paper›PMID 30560332›Full record

Observational studyDigestive diseases and sciences2019

Higher Mucosal Healing with Tumor Necrosis Factor Inhibitors in Combination with Thiopurines Compared to Methotrexate in Crohn's Disease.

Abhinav Vasudevan, Ajay Raghunath, Shane Anthony, Cian Scanlon, Miles P Sparrow, Peter R Gibson, Daniel R van Langenberg

Abstract readComparative StudyMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Digestive diseases and sciences, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.9field-weighted citation impact, top 21% 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

4 citing papers in PubMed, 14 citations in OpenAlex.

  1. Review
  2. Article
  3. Review
  4. Article
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 3 institutions in 1 country.

Abhinav VasudevanDepartment of Gastroenterology and Hepatology, Eastern Health, Box Hill Hospital, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia. abhinav.vasudevan@monash.edu.ORCID http://orcid.org/0000-0001-5026-9014
Ajay RaghunathEastern Health Clinical School, Monash University, Box Hill, VIC, 3128, Australia.
Shane AnthonyEastern Health Clinical School, Monash University, Box Hill, VIC, 3128, Australia.
Cian ScanlonDepartment of Gastroenterology and Hepatology, Eastern Health, Box Hill Hospital, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
Miles P SparrowDepartment of Gastroenterology, Alfred Health, Monash University, Melbourne, VIC, 3004, Australia.
Peter R GibsonDepartment of Gastroenterology, Alfred Health, Monash University, Melbourne, VIC, 3004, Australia.
Daniel R van LangenbergDepartment of Gastroenterology and Hepatology, Eastern Health, Box Hill Hospital, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
Box Hill Hospital · AUAlfred Health · AUEastern Health · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe differential impact of anti-tumor necrosis factor (anti-TNF) therapy with methotrexate versus thiopurine co-therapy on endoscopic remission remains uncertain.

aimsTo compare rates of endoscopic remission based on methotrexate or thiopurine co-therapy used with anti-TNF therapy in Crohn's disease.

methodsA retrospective observational study at two tertiary centers between 2010 and 2016 compared endoscopic remission rates and persistence on anti-TNF therapy in combination with methotrexate versus thiopurines for at least 3 months.

resultsOf 412 patients on anti-TNF therapy, 278 (67%) received immunomodulator co-therapy for ≥ 3 months and 269 (65%) had complete data for analysis. Methotrexate was used in 77 (29%) and thiopurines in 192 (71%) patients plus either infliximab (156, 58%) or adalimumab (113, 42%), with median follow-up of 2.8 years. The methotrexate group had greater prior immunomodulator intolerance (62% vs 20%, p < 0.01). Endoscopic remission rates were higher in those treated with thiopurine compared to methotrexate co-therapy at 12 m (58% vs 17%, p < 0.01) and at last review (59% vs 40%, p = 0.03). Endoscopic remission rates were higher with thiopurines than methotrexate when combined with adalimumab (49% vs 6%, p < 0.01) but not with infliximab (65% vs 54%, p = 0.09). In multivariate analysis, thiopurine co-therapy, elevated baseline CRP, and therapeutic anti-TNF drug levels were each associated with longer persistence of co-therapy (each p < 0.05). There were no significant differences in adverse events, malignancy or infection rates.

conclusionIn this cohort, anti-TNF and thiopurine co-therapy resulted in higher rates of mucosal healing than methotrexate, the difference is most pronounced with adalimumab and conversely with low-dose methotrexate.

Indexed as

AdalimumabAdultBiological ProductsCrohn DiseaseDrug Therapy, CombinationFemaleHumansImmunosuppressive AgentsInfliximabIntestinal MucosaMaleMethotrexateMiddle AgedPurinesRetrospective StudiesTime FactorsAdalimumabBiological ProductsImmunosuppressive AgentsInfliximabMethotrexatePurinesTumor Necrosis Factor-alphaAdalimumabAzathioprineEndoscopyInfliximabMercaptopurine

Identifiers

PMID30560332
OpenAlexW2903822247

What OpenQuestion holds

Textmetadata
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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.