A meta-analysis of the therapeutic effects of tumor necrosis factor-α blockers on ulcerative colitis

Purpose To evaluate the therapeutic effects of TNF-alpha blockers on ulcerative colitis (UC) and their safety. Methods Randomized controlled trials (RCTs) of TNF-alpha blockers for treatment of UC were retrieved from databases. Heterogeneity test was performed on all data to select effects models. Finally, sensitivity analysis was carried out, and a funnel plot was drawn to evaluate publication bias. Results A total of nine RCTs conformed to the inclusion criteria. Of 1,226 patients with UC, 806 were given a TNF-alpha blocker, and 420 were given placebo or other drugs as control. Infliximab was used in eight papers and adalimumab in one paper. Placebo was used in seven papers and hormones in two papers. Short-term response, short-term relief, long-term response, and long-term relief were better in the TNF-alpha blocker group than in the control group (P<0.05). TNF-alpha blockers decreased the colectomy rate (P<0.05). There were no significant differences in mucosal healing and quality of life between the two groups (P>0.05). The rates of adverse reactions were similar in the two groups (P>0.05), but the rate of severe adverse reactions was significantly lower in the TNF-alpha blocker group than in the control group (P<0.05). The funnel plot of each parameter was symmetrical with the lower part broader than the upper. Conclusions TNF-alpha blockers have better therapeutic effects on moderate or severe UC, which shows little response to conventional therapy. TNF-alpha blockers can induce short-term response, maintain long-term clinical response and clinical relief, and decrease the colectomy rate and the severe adverse reaction rate, but they fail to improve quality of life and mucosal healing.