Efficacy And Safety Of Combination Therapy Of Infliximab And Enteral Nutrition For Crohn's Disease:A Meta-analysis

Objective:To evaluate the efficacy and safety of infliximab combined with enteral nutrition in the treatment of Crohn's disease by Meta-analysis.Methods:The clinical data of infliximab combined enteral nutrition therapy for Crohn's disease were obtained through searching the Chinese and English databases.The English databases searched include:The Cochrane Library,embase,pubmed(medline)and Web of Science.The searched Chinese databases include:Chinese Biomedical Literature Database,Wanfang Data Knowledge Service Platform,Chinese Journal Full-text Database,and Wep Periodical Resource Integration Service Platform.The retrieval time is until December 2017,and the retrieved documents are screened strictly according to the inclusion and exclusion criteria.The quality of the study after the screening was evaluated using the Effective Public Health Practice Project(EPHPP)model.The included study was analyzed by Meta-analysis with RevMan 5.3 software.The clinical remission rate,the improvement of biochemical indexes and the incidence of adverse events in the treatment of Crohn's disease with infliximab combined with enteral nutrition were statistically analyzed,while compared with other treatment methods and finally come to a conclusion.Results:A total of 10 articles were included,which contain a total of 11 studies,of which 7 studies compared IFX combined with EN and IFX monotherapy,3 studies compared the therapeutic effects of IFX combined with EN and AZA combined with EN,and 1 study compared the therapeutic effects of IFX combined with EN and IFX combined with TPN.The results of the analysis showed that the clinical remission rate of IFX combination with EN group was higher than that of IFX monotherapy group(OR =2.57,95%Cl:1.73-3.81,P<0.O0001).In terms of long-term remission rate,when compare of IFX monotherapy group with IFX combined with EN group,the effect of IFX combined with EN was more significant(OR =3.26,95%CI:1.89-5.62,P<0.0001).Compared with IFX monotherapy group,the use of EN reduced the incidence of loss of response to IFX(OR =2.96,95%CI:1.90-4.60,P<0.00001).The clinical remission rate of IFX combined with EN treatment of CD was higher than that of AZA combined with EN group(OR = 9.39,95%CI:3.16—27.93,P<0.0001).The clinical remission rate of IFX combined with EN group was similar to that of IFX combined TPN group(P>0.05).After 30 weeks of treatment,the CRP and ESR were significantly lower in the IFX combined EN group than in the AZA combined EN group(CRP group:SMD =-3.03,95%CI:-3.44?2.61,P<0.00001,ESR Group:MD =-0.38,95%CI:-0.71?0.04,P = 0.03).The incidence of adverse events in IFX combined with EN group was not significantly different from that in other treatment groups.(OR = 0.88,95%CI:0.40—1.94,P = 0.75),Conclusion:The combination of infliximab and enteral nutrition is effective in treating Crohn's disease.Moreover,there was no significant increase in the incidence of adverse reactions.