Use of the tumor necrosis factor-blockers for Crohn's disease

Table 10 Meta-analysis of efficacy and safety of anti-tumor necrosis factor α antibodies vs placebo (4 wk to 12 wk) in inducing remission in active luminal Crohn’s disease

Treatment	Outcome (RR of remission not achieving)
All biological vs PL	RR = 0.87; 95%CI: 0.80-0.94; NNT = 8 (95%CI: 6-17)
IFX vs PL1	RR = 0.68; 95%CI: 0.52-0.90, I2 = 78%, P = 0.01; NNT = 4 (95%CI: 3-7)
ADA vs PL	RR = 0.85; 95%CI: 0.79-0.91, I2 = 0%, P = 0.99; NNT = 7 (95%CI: 5-12.5)
CER vs PL	RR = 0.95; 95%CI: 0.90-1.01, I2 = 0%, P = 0.62
Natalizumab vs PL	RR = 0.88; 95%CI: 0.83-0.94, I2 = 0%, P = 0.72
Adverse effects
	No statistically significant difference in the incidence of adverse events was detected with TNFB vs placebo (RR of experiencing any adverse event, including infusion or injection site reactions = 0.99; 95%CI: 0.90-1.08
	With anti–α4–integrin antibodies (natalizumab) vs PL, significantly more patients reported headache (compared with placebo: RR = 1.23; 95%CI: 1.03 to 1.47, I2 = 0%)
	With NAT there were trends towards more infusion reactions (RR = 1.41; 95%CI: 0.94 to 2.10, I2 = 0%) and infections (RR = 1.12; 95%CI: 0.97 to 1.30, I2 = 0%)
	Number needed to harm with NAT = 17 (95%CI: 9-71)

Independent data extraction was undertaken by two reviewers, and discrepancies checked and resolved intention-to-treat. Analysis and pooled data with a random effects model was used, including the reporting of the search strategy, inclusion criteria, and data extraction processes.

¹Note that when the Sonic trail was excluded from analysis, there was no statistically significant difference between IFX vs placebo. RR: Risk ratio; IFX: Infliximab; ADA: Adalimumab; CER: Certolizumab; PL: Placebo; CI: Confidence interval; TNFB: Tumor necrosis factor-α blockers; NAT: Natalizumab; NNT: Needed to treat.