A Cochrane review [Abstract] 1 included 9 studies with a total of 3011 subjects. Infliximab maintains clinical remission (RR 2.50, 95% CI 1.64 to 3.80; 2 studies, n=404), maintains clinical response (RR 2.19, 95% CI 1.27 to 3.75; 2 studies, n=404), has corticosteroid-sparing effects (RR 3.13, 95% CI 1.25 to 7.81; 1 study, n=335), and maintains fistula healing (RR 1.87, 95% CI 1.15 to 3.04; 1 study, n=189) in patients with Crohn's disease with a response to infliximab induction therapy. There were no significant differences in remission rates between infliximab doses of 5 mg/kg or 10 mg/kg. Adalimumab maintains clinical remission (RR 2.50, 95% CI 1.37 to 4.57; 2 studies, n=554), and maintains clinical response (RR 2.69, 95% CI 1.88 to 3.86; 1 study, n=499) in patients with Crohn's disease who have responded or entered remission with adalimumab induction therapy. The pooled analysis for corticosteroid sparing effects was not statistically significant (RR 2.32, 95% CI 0.62 to 8.63, 2 studies, n=219). There were no significant differences in remission rates between adalimumab 40 mg weekly or every other week. Certolizumab pegol maintains clinical remission (RR 1.68, 95% CI 1.30 to 2.16) and maintains clinical response (RR 1.74, 95% CI 1.41 to 2.13; 1 study, n=425) in patients who have responded to certolizumab induction therapy. CDP571 seems not to be effective for maintenance of remission (RR 1.28, 95% CI 0.87 to 1.89; 2 studies, n=562), maintenance of clinical response (RR 1.30, 95% CI 0.91 to 1.85; 1 study, n=395), or corticosteroid-sparing (RR 0.80, 95% CI 0.56 to 1.14; 1 study, n=271) in Crohn's disease.
Adverse events are similar in the infliximab, adalimumab, and certolizumab groups compared with placebo, but study size and duration generally are insufficient to allow an adequate assessment of serious adverse events associated with long-term use.
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