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The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis

BACKGROUND: Infliximab (IFX) and calcineurin inhibitors (cyclosporine [CYS] and tacrolimus [TAC]) were considered as rescue therapy in steroid-refractory ulcerative colitis (UC). The objective of our study was to perform a meta-analysis evaluating the short-term and long-term efficacy and safety of...

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Autores principales: Zhao, Heng-Nan, Jiang, Min, Sun, Ming-Jun, Dai, Cong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448007/
https://www.ncbi.nlm.nih.gov/pubmed/34380865
http://dx.doi.org/10.4103/sjg.sjg_145_21
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author Zhao, Heng-Nan
Jiang, Min
Sun, Ming-Jun
Dai, Cong
author_facet Zhao, Heng-Nan
Jiang, Min
Sun, Ming-Jun
Dai, Cong
author_sort Zhao, Heng-Nan
collection PubMed
description BACKGROUND: Infliximab (IFX) and calcineurin inhibitors (cyclosporine [CYS] and tacrolimus [TAC]) were considered as rescue therapy in steroid-refractory ulcerative colitis (UC). The objective of our study was to perform a meta-analysis evaluating the short-term and long-term efficacy and safety of IFX and calcineurin inhibitors in steroid-refractory UC. METHODS: We systematically searched the databases from inception to September 2020 that evaluated IFX, CYS, and TAC in steroid-refractory UC. The primary outcome was the response rates, remission rates, mucosal healing rates, and colectomy rates after therapy initiation. The secondary outcomes were the rates of adverse events (AE), serious adverse events (SAE), and mortality. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated. RESULTS: Nineteen studies comprising 1323 Acute severe ulcerative colitis (ASUC) patients were included in the meta-analysis. Among the non-randomized studies, a significantly higher therapeutic response rate was seen with IFX treatment, with a pooled OR of 3.15 (95% CI 2.26–4.40). Among non-randomized studies, IFX was associated with a significantly lower first-year OR (0.46 [95% CI 0.27–0.79]), second-year (OR 0.53 [95% CI 0.28–0.97]), third-year (OR 0.43 [95% CI 0.24–0.75]) colectomy rate. But the randomized controlled trials (RCTs) did not suggest any difference between IFX and CYS as rescue therapies for steroid-refractory UC. There were no significant differences among IFX, CYS, and TAC in the rates of AE, SAE, or mortality. CONCLUSION: Our meta-analysis suggested a better treatment response rate and lower risk of colectomy in the first, second and third year, with IFX, compared with CYS in steroid-refractory UC patients. There was no significant difference among IFX and calcineurin inhibitors in AE, SAE, and mortality.
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spelling pubmed-84480072021-10-04 The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis Zhao, Heng-Nan Jiang, Min Sun, Ming-Jun Dai, Cong Saudi J Gastroenterol Systematic Review/Meta Analysis BACKGROUND: Infliximab (IFX) and calcineurin inhibitors (cyclosporine [CYS] and tacrolimus [TAC]) were considered as rescue therapy in steroid-refractory ulcerative colitis (UC). The objective of our study was to perform a meta-analysis evaluating the short-term and long-term efficacy and safety of IFX and calcineurin inhibitors in steroid-refractory UC. METHODS: We systematically searched the databases from inception to September 2020 that evaluated IFX, CYS, and TAC in steroid-refractory UC. The primary outcome was the response rates, remission rates, mucosal healing rates, and colectomy rates after therapy initiation. The secondary outcomes were the rates of adverse events (AE), serious adverse events (SAE), and mortality. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated. RESULTS: Nineteen studies comprising 1323 Acute severe ulcerative colitis (ASUC) patients were included in the meta-analysis. Among the non-randomized studies, a significantly higher therapeutic response rate was seen with IFX treatment, with a pooled OR of 3.15 (95% CI 2.26–4.40). Among non-randomized studies, IFX was associated with a significantly lower first-year OR (0.46 [95% CI 0.27–0.79]), second-year (OR 0.53 [95% CI 0.28–0.97]), third-year (OR 0.43 [95% CI 0.24–0.75]) colectomy rate. But the randomized controlled trials (RCTs) did not suggest any difference between IFX and CYS as rescue therapies for steroid-refractory UC. There were no significant differences among IFX, CYS, and TAC in the rates of AE, SAE, or mortality. CONCLUSION: Our meta-analysis suggested a better treatment response rate and lower risk of colectomy in the first, second and third year, with IFX, compared with CYS in steroid-refractory UC patients. There was no significant difference among IFX and calcineurin inhibitors in AE, SAE, and mortality. Wolters Kluwer - Medknow 2021-08-03 /pmc/articles/PMC8448007/ /pubmed/34380865 http://dx.doi.org/10.4103/sjg.sjg_145_21 Text en Copyright: © 2021 Saudi Journal of Gastroenterology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Systematic Review/Meta Analysis
Zhao, Heng-Nan
Jiang, Min
Sun, Ming-Jun
Dai, Cong
The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis
title The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis
title_full The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis
title_fullStr The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis
title_full_unstemmed The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis
title_short The efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory UC patients: A meta-analysis
title_sort efficacy and safety of infliximab and calcineurin inhibitors in steroid-refractory uc patients: a meta-analysis
topic Systematic Review/Meta Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448007/
https://www.ncbi.nlm.nih.gov/pubmed/34380865
http://dx.doi.org/10.4103/sjg.sjg_145_21
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