Efficacy and prognosis of adalimumab for Crohn's disease at different disease locations: a systematic review and meta-analysis

OBJECTIVE: For over ten years, adalimumab (ADA) has been approved for treating active moderate to severe Crohn's disease (CD), showing irreplaceable efficacy. However. the difference in efficacy and prognosis when the disease pathology occurs in different locations of the body is still unclear. This study used systematic meta-analysis to assess the efficacy of ADA and prognosis in CD in different locations of disease pathology. MATERIALS AND METHODS: We used "Adalimumab OR ADA OR HUMIRA OR IgG1 monoclonal antibody" AND "Crohn disease OR Crohn's disease OR CD OR IBD OR inflammatory bowel disease - as search strategies for searching electronic databases in the Embase, PubMed and CNKI databases. A systematic meta-analysis of proportions was performed to analyze the data. RESULTS: A total of 1.253 patients in 15 articles were included in our study. The results showed that treatment with ADA led to overall remission rates that were elevated (70%, 95% CI: 58%-79%) but a nonnegligible overall relapse rate (28%. 95% CI: 12%-53%) in patients with CD. More importantly, we indicated that the use of ADA in patients with colon only (L2). ileum and colon (L3) and upper gastrointestinal tract (L4) CD led to significantly lower clinical remission rates. The use of ADA in patients with L2 led to significantly higher relapse rates, but the use of ADA in patients with ileum only (L1) and L3 CD led to significantly lower relapse rates. CONCLUSIONS: Our findings clarify different remission and relapse rates depending on the location of the disease pathology and may be useful for clinicians' choice of treatment strategies.