A Meta Analysis:the Combination Therapy Of Infliximab And Azathioprine And Infliximab And Enteral Nutrition In Crohn's Disease

Objective:A series of recent studies show the efficacy of infliximab combined with azathioprine,infliximab and enteral nutrition in Crohn's disease is superior to infliximab alone,and this two combination treatments do not increase the incidence of adverse reactions.But there is no direct comparison between the two related researchs.In order to provide a more optimal treatment for the Crohn's disease,this indirect meta-analysis is intended to compare the efficacy and the safety of IFX+AZA and IFX+EN in the treatment of Crohn's disease.Methods : PubMed,Medline,Cochrane Library,Embase,CNKI,Wanfang,VIP and China Biomedical Document Service System(CBM)were retrievaled by the computer.The prospective randomized controlled clinical trial(RCT),cohort study,or meta-analysis of comparison of infliximab combined with azathioprine vs infliximab or infliximab combined with enteral nutrition vs infliximab is selected for this study,selecting efficacy and adverse event rates as the endpoints of the study,comparing the efficacy and safety between infliximab combined withazathioprine and infliximab combined with enteral nutrition through indirect comparisons.Results:Eventually 8 studies were included,including 5 randomized controlled trials and 2 cohort studies that comparing IFX+AZA with IFX,1meta-analysis of IFX+EN and IFX.The efficacy of IFX compared with IFX+AZA shows that IFX+AZA was better than IFX(OR=1.70,95%CI=1.26-2.29,Z=3.44,P=0.0006),and there was no significant difference in safety(OR=0.99,95% CI= 0.64-1.53,Z = 0.05,P = 0.96).The meta-analysis which comparing IFX and IFX+EN showed that the efficacy of IFX+EN was better than IFX(OR=2.38,95% CI=1.65-3.42,Z=4.66,P<0.00001),and there was no significant difference in safety(OR= 0.73,95% CI = 0.12-4.45,Z = 0.34,P = 0.73).Indirect comparison of IFX+AZA and IFX+EN by ITC showed that there was no significant difference in the efficacy of IFX+AZA compared with IFX+EN(OR=0.714,95%CI=0.446-1.144,P>0.05),and there was no significant difference in safety between IFX +AZA and IFX+EN(OR=1.356,95% CI=0.611-8.698,P>0.05).Conclusion : Infliximab in combination with azathioprine and infliximab in combination with enteral nutrition have a better efficacy in the treatment of moderate-severe Crohn's disease and no significant difference in safety when comparing with infliximab;When it comes to efficacy and safety,there are no difference between infliximab incombination with azathioprine and infliximab in combination with enteral nutrition.