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

Table 33 Meta-analysis of efficacy of immunosuppressive therapy to induce remission or to prevent relapse in Crohn's disease and ulcerative colitis

		Induce remission (RR of not being in remission on active therapy)	Prevent relapse (RR of relapse)
CD	AZA/6-MP vs placebo/no therapy	0.87 (95%CI: 0.71-1.06)	0.64 (95%CI: 0.34-1.23)
		If OR was used rather than RRs as the summary statistic, then “the result was significant, using a random effects model (OR = 0.42; 95%CI: 0.2-0.89)	There was no statistically significant benefit for continuing AZA to prevent CD relapse (RR = 0.39; 95%CI: 0.21-0.74)
	MTX vs placebo	0.82 (95%CI: 0.65-1.03), no statistically significant benefit	IM MTX: 0.57 (95%CI: 0.35-0.94); NNT = 4 (95%CI: 2-25) to prevent one relapse
		If or used, then the result was statistically significant: OR = 0.47; 95%CI: 0.23-0.99	PO MTX to facilitate steroid withdrawal: 0.82 (95%CI: 0.58-1.17)
	Cyclosporine vs placebo (only one trial)	0.84 (95%CI: 0.62-1.07; tacrolimus, one study, no improvement: RR = 0.64; 95%CI: 0.44-0.92)	0.96 (95%CI: 0.77-1.20)
UC	AZA vs placebo	0.85 (95%CI: 0.71-0.01, P = 0.07)	0.60 (95%CI: 0.37-0.95, P = 0.03); NNT = 4, 95%CI: 2-10)
	MTX vs placebo	0.59 (95%CI: 0.04-7.90)

UC: Ulcerative colitis; AZA: Azathioprine; MTX: Methotrexate; RR: Risk ratio; OR: Odds ratio; NNT: Needed to treat; CI: Confidence interval; IM: Intramuscular; PO: Oral; CD: Crohn's disease; 6-MP: 6-mercaptopurine.