Meta Analysis Of Anti-tumor Necrosis Factor-α Monotherapy And Combined With Aminosalicylic Acid In The Treatment Of Ulcerative Colitis

Objective:For patients with ulcerative colitis(UC)who have been upgraded to anti-titumor necrosis factor(TNF)-αtherapy,the efficacy and safety of anti-TNF-αmonotherapy monoclonal antibody and combined 5-aminosalicylic acid(ASA)therapy were compared,in order to provide evidence for clinicians when choosing medication regimen for UC patients.Methods:Various Chinese and English databases were searched using the combination of subject words and free words to collect the comparison between anti-TNF-αmonoclonal antibody and combined 5-ASA treatment in UC patients.Clinical remission was used as the primary endpoint,and endoscopic remission and adverse events were used as the secondary endpoint.Literature screening and data extraction were conducted after inclusion and exclusion criteria were established.Newcastle-Ottawa Scale(NOS)was used for literature quality evaluation,and Revman software was used for data analysis.First,the included papers were analyzed for heterogeneity,and corresponding effect models were selected according to the heterogeneity results.The final results were expressed by odds ratio(OR)and95%confidence interval(CI).P<0.05 was considered to be statistically significant,and funnel plot was used to evaluate publication bias.Results:According to the inclusion and exclusion criteria,6 literatures with a total of6326 patients were included.NOS carried out quality evaluation,all of which were 6stars or above.The outcome indicators of three articles included clinical remission.Heterogeneity test was conducted,I~2=0%,P=0.87.Fixed-effect model analysis was adopted,and the results showed that the clinical remission rate of continued use of5-ASA after upgrading to anti-TNF-αmonoclonal antibody was lower,but the difference was not statistically significant(OR=0.82,P=0.11,95%CI=0.64-1.05).The outcome indicators of two articles included endoscopic remission.Heterogeneity test was conducted,I~2=69%,P=0.07,indicating heterogeneity,but I~2<75%.Random-effects model analysis was adopted,and results showed that the endoscopic remission rate was lower in those who continued to use 5-ASA after being upgraded to anti-TNF-αmonoclonal antibody.However,the difference was not statistically significant(OR=0.73,P=0.56,95%CI=0.25-2.11).A total of 4articles had outcome indicators containing adverse events,which were tested for heterogeneity,I~2=0%,P=0.68.Fixed-effect model was used to analyze,and the results showed that the incidence of adverse events was lower when continued use of5-ASA after upgrading to anti-TNF-αmonoclonal antibody,but the difference was not statistically significant(OR=0.90,P=0.11,95%CI=0.78-1.03).Conclusion:For patients with UC who have been upgraded to anti-TNF-αmonoclonal antibody therapy,continuing 5-ASA therapy does not benefit from clinical and endoscopic remission,nor does it reduce the risk of adverse events.