ArticleTherapeutic advances in gastroenterology2025
Systematic review and network meta-analysis comparing the efficacy of conventional therapy and biologics to prevent endoscopic postoperative recurrence in patients with Crohn's disease.
Article in Therapeutic advances in gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Essential Updates in the Surgical Management of Inflammatory Bowel Disease: Current Topics From 2024 to Mid-2026.Annals of gastroenterological surgery · 2026Review
- Benefits of Surgical Management in Ileocecal Crohn's Disease: A Review of the Past Decade (2020-2026).Medicina (Kaunas, Lithuania) · 2026Review
- Postoperative Recurrence in Crohn's Disease: Pathophysiology, Risk Stratification, and Management Strategies.Journal of clinical medicine · 2025Review
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3 authors.
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Abstract
Background: As no direct comparison is available between drugs to prevent endoscopic postoperative recurrence (POR) in Crohn's disease (CD), hierarchizing these therapeutic options remains challenging. Objectives: We aimed to compare the effectiveness of treatments to prevent CD endoscopic POR. Design: Systematic review and network meta-analysis using a random-effects model. Data sources and methods: We include studies comparing treatments to prevent CD POR according to PRISMA guidelines. The primary endpoint was endoscopic POR (Rutgeerts score ⩾i2). Surface under the cumulative ranking (SUCRA) was used to hierarchize the treatments. Results: Twenty studies were included (2414 patients). Overall heterogeneity was moderate (τ = 0.34). Ustekinumab (odds ratio (OR) = 0.23 (0.07-0.70); OR = 0.29 (0.08-0.99)), vedolizumab (OR = 0.17 (0.05-0.59); OR = 0.22 (0.06-0.85)), infliximab (OR = 0.18 (0.36-0.88); OR = 0.23 (0.09-0.54)), and adalimumab (OR = 0.17 (0.07-0.42); OR = 0.22 (0.08-0.59)) were more effective to prevent endoscopic POR than placebo or 5-ASA, respectively, contrary to thiopurines (OR = 0.52 (0.22-1.24); OR = 0.66 (0.25-1.76)). Adalimumab (OR = 0.33 (0.15-0.74)) and infliximab (OR = 0.34 (0.13-0.87)) were more effective than thiopurines. While no difference was observed between the four biologics, adalimumab (SUCRA = 0.81), infliximab (SUCRA = 0.80), vedolizumab (SUCRA = 0.79), and ustekinumab (SUCRA = 0.72) had the highest likelihood of being the most effective drug, contrary to thiopurines (SUCRA = 0.41), 5-ASA (SUCRA = 0.24), or placebo (SUCRA = 0.16). Conclusion: This network meta-analysis confirms the efficacy of anti-TNF agents, vedolizumab, and ustekinumab in preventing endoscopic CD POR without any difference between them. When a prophylactic therapy is needed, biologics should be preferred to 5-ASA or thiopurines. Trial registration: PROSPERO registration number CRD42024555528.
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