Abstract
Purpose This study aimed to evaluate the therapeutic value of adalimumab (ADA) for fistula in Crohn's disease (CD). Methods A computerized search of electronic databases, including PubMed, Web of Science, Embase, Google scholar, and the Cochrane Library from 2000 to October 2016, was performed. Randomized controlled trials (rcts) or nonrandomized controlled trials (n-rcts) were included in this article to evaluate the role of ADA in the management of fistula in CD. The methodological index for nonrandomized studies (MINORS evaluation tools) was used to assess the quality of every study. Result Overall, seven studies and 379 patients comforted to the inclusion criteria of this meta-analysis. The result showed that 36% (95% CI: 0.31–0.41) of patients with complete fistula closure and 31% (95% CI: 0.031–0.61) of patients with partial response were received in CD with ADA treatment. Conclusion We concluded that ADA is effective and safe for the treatment of fistula in CD according to current evidence.
Highlights
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing, and fistula secondary to transmural inflammation [1]
The considerable morbidity of CD is associated with fistulas, and up to 50% of CD patients are affected by fistulas [2]
Clinical trials were researched through PubMed, Web of Science, Embase, Google scholar, and the Cochrane Library and used the following keywords: tumor necrosis factor, anti-TNF, TNF, adalimumab, Crohn’s disease, fistula, randomized, randomly, and clinical trials between 2000 and October 2016; seven studies were selected, and all these studies in this
Summary
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing, and fistula secondary to transmural inflammation [1]. A randomized clinical trial showed that infliximab (IFX) can effectively induce and maintain the closure of perianal fistulas in CD patients [7]. ADA is a full human IgG1 monoclonal antibody to TNF that is effective in inducing and maintaining clinical response or remission in active inflammatory CD patients [11], as well as in managing the fistulas. These data are only available from subgroups in larger CD studies not designed to assess the fistula response [12,13,14,15,16,17]. We evaluate the efficacy of ADA for fistula CD through one meta-analysis of randomized placebo-controlled trials collecting up-to-date reviews
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