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Coward S, Kuenzig ME, Hazlewood G, et al. Comparative Effectiveness of Mesalamine, Sulfasalazine, Corticosteroids, and Budesonide for the Induction of Remission in Crohn's Disease: A Bayesian Network Meta-analysis: Republished. Inflamm Bowel Dis. 2017;23(5):E26-E37doi: 10.1097/MIB.0000000000001158.
Coward, S., Kuenzig, M. E., Hazlewood, G., Clement, F., McBrien, K., Holmes, R., Panaccione, R., Ghosh, S., Seow, C. H., Rezaie, A., & Kaplan, G. G. (2017). Comparative Effectiveness of Mesalamine, Sulfasalazine, Corticosteroids, and Budesonide for the Induction of Remission in Crohn's Disease: A Bayesian Network Meta-analysis: Republished. Inflammatory bowel diseases, 23(5), E26-E37. https://doi.org/10.1097/MIB.0000000000001158
Coward, Stephanie, et al. "Comparative Effectiveness of Mesalamine, Sulfasalazine, Corticosteroids, and Budesonide for the Induction of Remission in Crohn's Disease: A Bayesian Network Meta-analysis: Republished." Inflammatory bowel diseases vol. 23,5 (2017): E26-E37. doi: https://doi.org/10.1097/MIB.0000000000001158
Coward S, Kuenzig ME, Hazlewood G, Clement F, McBrien K, Holmes R, Panaccione R, Ghosh S, Seow CH, Rezaie A, Kaplan GG. Comparative Effectiveness of Mesalamine, Sulfasalazine, Corticosteroids, and Budesonide for the Induction of Remission in Crohn's Disease: A Bayesian Network Meta-analysis: Republished. Inflamm Bowel Dis. 2017 May 01;23(5):E26-E37. doi: 10.1097/MIB.0000000000001158. PMID: 30052985.
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Inflamm Bowel Dis. 2017 May 01;23(5):E26-E37. doi: 10.1097/MIB.0000000000001158.

Comparative Effectiveness of Mesalamine, Sulfasalazine, Corticosteroids, and Budesonide for the Induction of Remission in Crohn's Disease: A Bayesian Network Meta-analysis: Republished.

Inflammatory bowel diseases

Stephanie Coward, M Ellen Kuenzig, Glen Hazlewood, Fiona Clement, Kerry McBrien, Rebecca Holmes, Remo Panaccione, Subrata Ghosh, Cynthia H Seow, Ali Rezaie, Gilaad G Kaplan

Affiliations

  1. Departments of Medicine and Community Health Sciences.
  2. Departments of Community Health Sciences.
  3. Departments of Medicine, University of Calgary, Calgary, Alberta, Canada.
  4. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.

PMID: 30052985 DOI: 10.1097/MIB.0000000000001158

Abstract

BACKGROUND: Induction treatment of mild-to-moderate Crohn's disease is controversial.

PURPOSE: To compare the induction of remission between different doses of mesalamine, sulfasalazine, corticosteroids, and budesonide for active Crohn's disease.

DATA SOURCES: We identified randomized controlled trials from existing Cochrane reviews and an updated literature search in Medline, EMBASE, and CENTRAL to November 2015.

STUDY SELECTION: We included randomized controlled trials (n = 22) in adult patients with Crohn's disease that compared budesonide, sulfasalazine, mesalamine, or corticosteroids with placebo or each other, for the induction of remission (8-17 wks). Mesalamine (above and below 2.4 g/d) and budesonide (above and below 6 mg/d) were stratified into low and high doses.

DATA EXTRACTION: Our primary outcome was remission, defined as a Crohn's Disease Activity Index score <150. A Bayesian random-effects network meta-analysis was performed on the proportion in remission.

DATA SYNTHESIS: Corticosteroids (odds ratio [OR] = 3.64; 95% credible interval [CrI]: 2.16-6.19), high-dose budesonide (OR = 2.99; 95% CrI: 1.83-4.90), and high-dose mesalamine (OR = 1.87; 95% CrI: 1.14-3.15) were superior to placebo. Corticosteroids were similar to high-dose budesonide (OR = 1.21; 95% CrI: 0.79-1.89), but more effective than high-dose mesalamine (OR = 1.95; 95% CrI: 1.14-3.25). Sulfasalazine was not significantly superior to any therapy including placebo.

LIMITATIONS: Randomized controlled trials that use a strict definition of induction of remission and disease severity at enrollment to assess effectiveness in treating mild-to-moderate Crohn's disease are limited.

CONCLUSIONS: Corticosteroids and high-dose budesonide were effective treatments for inducing remission in mild-to-moderate Crohn's disease. High-dose mesalamine maybe an option among patients preferring to avoid steroids.

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