Meta-analysis of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn's disease (CD)

We performed a meta-analysis to compare the clinical and endoscopic recurrence of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn's disease. Trials were located through Medline, Embase, the Cochrane Central Register of Controlled Trials, Ovid, Sciencedirect, and Ingenta electronic databases. From 124 articles screened, 14 were identified as randomized placebo-controlled trials and were included for data extraction. Main outcome measures were clinical recurrence, endoscopic recurrence, and severe endoscopic recurrence. The meta-analysis was performed with the fixed-effects model. Fourteen studies with 1,497 participants were analyzed. In the intention-to-treat analysis, medical treatment was associated with a significantly lower incidence of clinical recurrence (relative risk of 0.74, 95% confidence interval 0.64-0.87, P = 0.000], but there were no significant differences in endoscopic recurrence (0.94, 0.83-1.07, P = 0.353) and severe endoscopic recurrence (0.83, 0.60-1.16, P = 0.281) between the two groups. When using per-protocol analysis, the results is similar, medical treatment was associated with a significantly lower incidence of clinical recurrence (0.84, 0.72-0.97, P = 0.020), but there were no significant differences in endoscopic recurrence (0.94, 0.85-1.05, P = 0.268) or severe endoscopic recurrence (0.76, 0.55-1.04, P = 0.084) between the two groups of patients. Medical treatment has a sufficiently beneficial effect on decreasing the risk of clinical postoperative recurrence in patients with CD.