P365 Biological interventions for induction and maintenance of mucosal healing in Crohn’s disease: A Cochrane systematic review

Abstract

Background: Clinical trials of biologics in Crohn's disease (CD) have focused on clinical outcomes. Their ability to achieve mucosal healing (MH) is less clear. In this Cochrane review, we synthesised the randomised controlled trial (RCT) data on biologics for inducing and maintaining MH in CD. Method(s): MEDLINE, EMBASE, Cochrane Library (CENTRAL) and the Cochrane IBD Group Specialised Trials Register were searched to October 2017 for RCTs examining biologics for inducing and/or maintaining MH in CD at 4-26 and >26 weeks, respectively. Secondary outcomes were endoscopic response (ER), safety and quality of life (QOL). Pooled risk ratios (RR) were calculated using a random-effects model. The quality of the evidence was rated using GRADE. Result(s): The search yielded 7 induction trials (5 low, 2 unclear risk of bias). Infliximab (IFX) was superior to placebo (PBO) for inducing MH at week 10 (RR 8.4, 95% CI 1.2-61, n = 74, low quality), and IFX mono-and combination therapy with azathioprine (AZA) were superior to AZA for inducing MH at week 26 (RR 1.9, 95% CI 1.1-3.1, n = 218, low quality, and RR 2.7, 95% CI 1.7-4.3, n = 232, moderate quality). MH rates did not differ significantly between adalimumab (ADA) and PBO-treated patients, but ADA users were more likely to achieve CDEIS