Efficacy And Safety Of Infliximab Plus Azathioprine For Crohn’s Disease:A Meta-Analysis

Objectives: Infliximab(IFX)and azathioprine(AZA)are the most commonly used drugs for Crohn’s disease(CD).This meta-analysiswasaimedto evaluate the efficacy and safety of infliximabplus azathioprine(IFXpA)for CD.Methods: The articles on Infliximab plus Azathioprine for CD were searched by CNKI,Wanfang,PubMed,The Cochrane Library,and Embass.Revman software was used to analyze the clinical remission rate(CRr),C-reactive protein(CRP),albumin(ALB),white blood cell(WBC),erythrocyte sedimentation rate(ESR),endoscopic mucosal healing rate(MHr),adverse drug reactions and other indicators.Relative risk(RR)、weight mean difference(WMD),and 95% confidence interval(CI)were calculated.Sensitivity analysis and publication bias test were also conducted.Results:A total of 16 articles with a sample of 1953 patients were included in this Meta-analysis.The CRr in patientes with IFXpA was 50.34%,and the MHr was 35.48%,which were superior to those with AZA[CRr=29.68%,RR=1.68,95% CI 1.46~1.94,p<0.000001;MHr = 12.83%,RR = 2.77,95% CI 2.04-3.75,p<0.00001].However,the adverse reaction rates between the two groups were not statistically significant(46.62% in Group IFXpA,and 47.62% in Group AZA,RR=0.95,95% CI 0.86 ~1.05,p = 0.32].Subgroup analysis of Chinese literature showed that the CRr(46.36%)and MHr(31.84%)in patients with IFXpA were significantly higher than those in Group AZA(CRr = 29.65%,RR = 1.56,95% CI 1.30~1.88,p<0.00001;and MHr = 10.22%,RR = 3.13,95% CI 2.05~4.78,p<0.00001).And the adverse reaction rates were also not statistically significant between the two groups(25.07% in IFXpA,and 29.11% in Group AZA,RR=0.86,95% CI 0.69-1.08,p=0.19].When compared the results in Group IFXpA with those in Group IFX,the CRr(50.38%)and MHr(42.41%)in Group IFXpA were significantly higher than those in Group IFX(CRr=33.86%,RR=1.27,95% CI1.10-1.47,p=0.001;and MHr=28.99%,RR=1.46,95% CI 1.17-1.83,p=0.001]).And the adverse reaction rates were also not statistically significant(54.64% in Group IFXpA,and 52.35% in Group IFX,RR=1.01,95% CI 0.92~1.11,,p=0.77).When compared the results in Group IFXpA with those in other drugs,the CRr(60%)and MHr(70.49%)in Group IFXpA were superior to those in other drugs(CRr=35.94%,RR=1.67,95% CI 1.14~2.45,p=0.009;and MHr=18.97%,RR=2.40,95% CI 1.24~4.65,p=0.009).And the adverse reaction rates were not statistically significant again(.18.7% in Group IFXpA,and 17.21% in other drugs,RR=1.08,95% CI 0.65~ 1.78,p = 0.76).Subgroup analysis of Chinese literature also showed the same results.Conclusions: Infliximab combined with azathioprine could significantly improve the clinical remission rate and endoscopic healing rate in CD patients without increasing the adverse effects.