Meta-analysis Of Anti-tumor Necrosis Factor Drugs Monotherapy Or Combined With Azathioprine For Inflammatory Bowel Disease

Objectives: Using the method of Meta-analysis,systematically evaluate the efficacy and safety of anti-tumor necrosis factor monotherapy and anti-tumor necrosis factor drugs combined with azathioprine in the treatment of inflammatory bowel disease.Methods: The authors search Pub Med,EMBASE,Cochrane Library,CBM,CNKI,Wangfang database,and VIP database since the establishment.Screen for randomized controlled trials(RCT)about treatment of inflammatory bowel disease with Anti-TNF monotherapy or in combination with azathioprine according to inclusion and exclusion criteria.Extract key information from the full text of included literature readings,and use the Cochrane bias risk scoring system to evaluate the quality of the included literature.Use Rev Man 5.3 software for statistical analysis and complete statistical merging,heterogeneity test,sensitivity analysis and publication bias assessment.primary outcomes of the assessment include response rate,clinical remission rate and total incidence of adverse events.Results: Meta analysis included 14 RCTs,a total of 1652 patients.The results showed that response rate(RR=1.22,95%CI:1.14-1.30),clinical remission rate(RR=1.24,95%CI:1.03-1.49)and mucosal healing rate(RR=1.37,95%CI:1.15-1.63)of the combination group of anti-TNF and AZA were higher than those of anti-TNF monotherapy group.The sensitivity analysis showed that the stability of the analysis results of clinical remission rate was poor.The total incidences of adverse events in the combination group and the monotherapy group were similar,and the difference was not statistically significant(RR=0.96,95%CI:0.87-1.06,P=0.44).The incidence of infection,abnormal liver function and adverse events leading to drug withdrawal were similar in the combination group and the monotherapy group.But the incidence of gastrointestinal reactions in the combination group was significantly higher(RR=2.94,95%CI:1.22-7.07).Conclusions: In the treatment of inflammatory bowel disease,the combined use of azathioprine can significantly improve the response rate and mucosal healing rate of anti-tumor necrosis factor drugs.And it will not increase the total incidence of adverse events during the medication process.Overall,combination therapy is safe and effective.