| IBD is a kind of chronic intestinal inflammatory disesse of similar pathologic basis and clinical presentation.Its etiology and pathogenesis is still not very clear now.The clinical features of the disease are long course and recurrent attacks.IBD mainly includes UC and CD.The morbidity of the disease is rising in Asian region including our country.It affect the quality of patients’ life seriously,so the emphasis is on it.The usual cures mainly include aminosalicylic acid preparations,corticosteroids and so on.The corticosteroid is effective in most patients,it can relieve their symptoms.But still a part of patients have the problem of being poor responsed to the standard dose of the corticosteroids or being resistant to the corticosteroids.We call this kind of IBD the moderate to severe steroid-refractory IBD.To this part of patients,the main rescue therapies include immunosuppressants,anti-TNF-α and so on.A number of clinical studies have approved that the immunosuppressants and the anti-TNF-α are both more effective in steroid-refractory IBD than usual cures.While there are some differences about the efficacies and securities between two kind of drugs in the studies,so how to choose the drug which is more effective、safer and cheaper has become the hot spot.At present most experts and scholars think that the IBD is a kind of intestinal inflammation caused by the abnormity of the inherent immunity and acquired immunity of the intestinal mucosa by the interaction of various of susceptible factors and pathogenic factors.Many studies have approved that the immunosuppressants(ciclosporin、azathioprine and so on) are effective in the rescue therapy of moderate to severe steroid-refractory IBD.On the other hand,the effect of TNF-α in the pathogenesis of the IBD is widely studied.The infliximab,seen as the representative of the anti TNF-α,is a kind of monoclonal antibody of anti TNF-α,it can induce the apoptosis of the inflammatory cells which express TNF-α,thus to inhibit the inflammatory process and to have the clinical treatment effect.Multiple studies have shown that infliximab is effective in inducing remission and maintenance treatment of the moderate to severe steroid-refractory IBD.1.Study on the efficacy and safety of the anti-TNF-α(infliximab,IFX) and the immunosuppressant(ciclosporin,Cs A) in treatment of moderate to severesteroid-refractory ulcerative colitis.Objective: To evaluate the efficacy and safety of anti-TNF-α(infliximab) and immunosuppressant(ciclosporin) in treatment of steroid-refractory ulcerative colitis.Methods: All relevant studies were searched by Cochrane library, Pubmed, Google Scholar, CKNI, Wanfang Date,CBMdatebase with the words of infliximab,anti-TNF-α,ciclosporin,immunosuppressant,ulcerativecolitis,IBD,randonmized controlled trials.Extract the information and data of the literature one by one.Cacluated the risk ratio in the Review Manager version 5.2 and process the statistical analysis.Results: Overall, 7 papers were included in this Meta-analysis, for the comparison of the results of three-month colectomy rate between anti-TNF-α(infliximab) group and the immunosuppressant(ciclosporin) group,the rate of the immunosuppressant(ciclosporin) group was obviously higher than that of anti-TNF-α(infliximab) group(RR=2.19, 95%CI: 1.50-3.20, Z= 4.04, P<0.0001); for the comparison of the results of twelve-month colectomy rate between the anti-TNF-α(infliximab) group and the immunosuppressant(ciclosporin) group, the rate of immunosuppressant(ciclosporin)group was also obviously higher than that of anti-TNF-α(infliximab) group(RR=1.58, 95%CI: 1.19-2.09, Z=3.21, P=0.001), for the comparison of the difference of the medical complication(security), there is no obvious difference between two groups(RR=1.17,95%CI:0.70-1.95,Z=0.60,P=0.55).Conclution: The treatment effects of anti-TNF-α(infliximab) to the moderate to severe steroid-refractory ulcerative colitis is better than that of immunosuppressant(ciclosporin),while the drug safety between them is not obvious.2.Study on the efficacy and safety of the anti-TNF-α(infliximab) and the immunosuppressant(azathioprine,six-mercaptopurine,methotrexate) in treatment of moderate to severe steroid-refractory Crohn’s disease.Objective: To evaluate the difference of the efficacy and safety of anti-TNF-α(infliximab) and immunosuppressant(azathioprine,six-mercaptopurine,methotrexate)in treatmemt of moderate to severe steroid-refractory Crohn’s disease.Methods: All relevant studies were searched by Cochrane library,Pubmed, Google Scholar,CKNI,Wanfang Date,CBMdatebase with the words of infliximab,anti-TNF-α,azathioprine,six-mercaptopurine,methotrexate,immunosuppres sant,Crohn’s disease,IBD,randomized controlled trials.The literature references of the papers were also included.Extract the information and data of the literature one by one.Calculated the risk ratio and mean difference in the Review Manager version 5.2and process the statistical analysis.Results: Overall,7 papers( 6 studies) were included in the Meta-analysis,for the comparison of the results of clinical remission rate between the anti-TNF-α(infliximab)group and the immunosuppressant group,the rate of the anti-TNF-α(infliximab) group was higher than that of the immunosuppressant group(RR=1.39,95%CI:1.14-1.70,Z=3.22,P=0.001);for the comparison of the results of endoscopy efficient rate between the anti-TNF-α(infliximab) group and the immunosuppressant group,the rate of the anti-TNF-α(infliximab) group was also higher than that of the immunosuppressant group(RR=1.54,95%CI:1.08-2.20,Z=2.37,P=0.02),for the comparison of the difference of the medical complication(security), there is no obvious difference between two groups(RR=1.02,95%CI:0.93-1.12,Z=0.38,P=0.70).Conclution: The treatment effects of anti-TNF-α(infliximab) to the moderate to severe steroid-refractory Crohn’s disesse is better than that of the immunosuppressant(azathioprine,six-mercaptopurine,methotrexate),while the drug safety between them is not obvious. |
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