META Analysis Of Thalidomide And Its Analogues In The Treatment Of CD

Objective:To evaluate the efficacy and safety of thalidomide and its analogues(lenalidomide)in the treatment of Crohn's disease(CD)by meta-analysis.Methods:A comprehensive search of randomized controlled trials(RCT)and prospective non-randomized clinical trials of thalidomide(or lenalidomide)for the treatment of CD in PubMed,Cochrane Library,Embase,and China Knowledge Network and Wanfang Database,Select literature,extract data,and perform methodological evaluation according to established inclusion and exclusion criteria,and use Revman5.3 software for meta-analysis.For uncontrolled prospective non-randomized clinical trials,RevMan5.3 software was used for single group analysis.Results:A total of 12 studies(4randomized controlled trials,8 prospective,non-randomized clinical trials)were included,with a total of 419 patients.The results of the meta-analysis of RCT suggest that the clinical response of thalidomide and its analogues in the treatment of CD is RR=1.27,95% CI(1.03-1.56),P=0.03(P<0.05),and the clinical remission rate RR=1.34.95% CI(0.85-2.11),P=0.20(P>0.05),clinical remission rate of thalidomide for CD was RR=1.94,95% CI(1.04-3.61)P=0.04(P<0.05).Meta-analysis of prospective,non-randomized clinical trials suggested clinical response rate:RR =1.77,95% CI(1.28-2.46),P = 0.0006(P < 0.05),clinical remission rate:RR = 1.08,95% CI(0.67-1.74),P=0.76(P<0.05),endoscopic remission rate:RR=0.46,95% CI(0.22-0.95).P=0.04(P<0.05).The incidence of adverse reactions was 52.8%,mainly including lethargy,rash and dermatitis and peripheral neuropathy.Most patients were tolerated and relieved after stopping or reducing the dose.Conclusion:Thalidomide and its analogues can produce clinical response to CD.Thalidomide can induce clinical remission.The main adverse reactions in each study are lethargy,rash and peripheral neuropathy.Most of them are reversible.The above conclusions still need to be confirmed by more Multi-quality RCTstudies.