Effectiveness and risk associated with infliximab alone and in combination with immunosuppressors for Crohn's disease: a systematic review and meta-analysis.

OBJECTIVE Infliximab (IFX) monotherapy and IFX combined with immunosuppressors have been used in the treatment of Crohn's disease. However, the differences between combination therapy and IFX alone remain controversial. The aim of this meta-analysis was to evaluate the effectiveness and risk associated with combination therapy and IFX monotherapy. METHODS Systematic searches were performed for randomized controlled trials with PubMed, Web of Science, OVID, and the Cochrane Library. The analyzed contents included induction of remission, short-term maintenance of remission, long-term maintenance of remission, and risks. The final results were estimated using statistical data of odds ratio (OR), relevant 95% confidence interval (CI), and P value. RESULTS 6 out of 1041 citations met the selection criteria. There was no statistical difference in the effectiveness of induction and long-term maintenance of remission between two groups (P=0.07, 0.12). However, for short-term maintenance of remission, there was mild statistical difference between two groups (P=0.02, OR=1.66). For risks, apart from the difference in the aspect of reaction to infusion (OR=0.43, 95% CI=0.29-0.65, P<0.0001), there was no statistical difference. CONCLUSIONS There was no significant difference in effectiveness and risks between the therapy groups. However, these outcomes should be interpreted with caution. Specific categories of combination therapy and periodic medication should be paid more attention in future studies.