SynthesisClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2021
Effect of Concomitant Therapy With Steroids and Tumor Necrosis Factor Antagonists for Induction of Remission in Patients With Crohn's Disease: A Systematic Review and Pooled Meta-analysis.
Synthesis in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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
12 citing papers in PubMed, 26 citations in OpenAlex.
- Article
- Concomitant 5-Aminosalicylic Acid Does Not Affect the Efficacy of Janus Kinase Inhibitors in Ulcerative Colitis.Clinical pharmacology and therapeutics · 2026Article
- Predictors of First Anti-TNF Treatment Failure in Patients with Inflammatory Bowel Disease: A Single-Center Cohort Study.Biomedicines · 2026Article
- Long-Term Outcomes and Therapeutic Strategies for Newly Diagnosed Crohn's Disease in the Biologic Era: A Nationwide Claims-Based Study from Japan.JMA journal · 2026Article
- Comparative Efficacy and Immunogenicity of Infliximab and Adalimumab in Crohn's Disease: A Prospective Cohort Study.Medicina (Kaunas, Lithuania) · 2025Article
- IL-36/IL-36R signaling promotes CD4Frontiers in immunology · 2025Article
- Common Mistakes in Managing Patients with Inflammatory Bowel Disease.Journal of clinical medicine · 2024Review
- Effects of prednisolone tapering on effectiveness of infliximab in patients with ulcerative colitis: data from a retrospective cohort.BMJ open gastroenterology · 2024Article
- Accelerating the Evolution of Immune-Related Enterocolitis Management.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Article
- Impact of Concomitant Corticosteroids on Tofacitinib Induction Efficacy and Infection Rates in Ulcerative Colitis.Digestive diseases and sciences · 2023Article
- Efficacy and tolerability of infliximab retreatment in patients with inflammatory bowel disease: a systematic review and meta-analysis.Therapeutic advances in chronic disease · 2021Article
- To immunosuppress: whom, when and how? That is the question with COVID-19.Annals of the rheumatic diseases · 2020Article
Corrections and comments
- Commented on by
- Commented on byReply.2022
Authors and funding
8 authors at 5 institutions in 2 countries.
Funding
Abstract
BACKGROUND &
aimsIt is not clear whether concomitant therapy with corticosteroids and anti-tumor necrosis factor (TNF) agents is more effective at inducing remission in patients with Crohn's disease (CD) than anti-TNF monotherapy. We aimed to determine whether patients with active CD receiving corticosteroids during induction therapy with anti-TNF agents had higher rates of clinical improvement than patients not receiving corticosteroids during induction therapy.
methodsWe systematically searched the MEDLINE, Embase, and CENTRAL databases, through January 20, 2016, for randomized trials of anti-TNF agents approved for treatment of CD and identified 14 trials (5 of adalimumab, 5 of certolizumab, and 4 of infliximab). We conducted a pooled meta-analysis of individual patient and aggregated data from these trials. We compared data from participants who continued oral corticosteroids during induction with anti-TNF therapy to those treated with anti-TNF agents alone. The endpoints were clinical remission (CD activity index [CDAI] scores <150) and clinical response (a decrease in CDAI of 100 points) at the end of induction (weeks 4-14 of treatment).
resultsWe included 4354 patients who received induction therapy with anti-TNF agents, including 1653 [38.0%] who were receiving corticosteroids. The combination of corticosteroids and an anti-TNF agent induced clinical remission in 32.0% of patients, whereas anti-TNF monotherapy induced clinical remission in 35.5% of patients (odds ratio [OR], 0.93; 95% CI, 0.74-1.17). The combination of corticosteroids and an anti-TNF agent induced a clinical response in 42.7% of patients, whereas anti-TNF monotherapy induced a clinical response in 46.8% (OR 0.84; 95% CI, 0.73-0.96). These findings did not change with adjustment for baseline CDAI scores and concurrent use of immunomodulators.
conclusionsBased on a meta-analysis of data from randomized trials of anti-TNF therapies in patients with active CD, patients receiving corticosteroids during induction therapy with anti-TNF agents did not have higher rates of clinical improvement compared with patients not receiving corticosteroids during induction therapy. Given these findings and the risks of corticosteroid use, clinicians should consider early weaning of corticosteroids during induction therapy with anti-TNF agents for patients with corticosteroid-refractory CD.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.