Systematic Review and Meta-analysis:Real-world Data Rates of Deep Remission With Anti-TNFα in Inflammatory Bowel Disease

Abstract Background & Aims Deep remission (DR) is a treatment target in IBD associated with reduced hospitalization and improved outcome. Randomized control trial (RCT) data demonstrates efficacy of anti-TNFα agents in achieving DR; however, RCTs may not be generalizable to clinical practice. In this systematic review with meta-analysis, we use real-world data (RWD) to determine rates of DR in IBD treated with anti-TNFα. Methods We completed a systematic search of MEDLINE and EMBASE on July 8, 2019 with review of major gastrointestinal conference abstracts from 2012-2019. Studies utilizing RWD (data not from phase I-III RCTs) of adult IBD patients treated with anti-TNFα agents were included. DR was defined by clinical and endoscopic remission at minimum. DR was assessed at 8 weeks, 6 months, 1 year, and 2 years.Results 29,033 publications were found on initial search. Fifteen publications, nine manuscripts and six conference abstracts, were included encompassing 1,212 patients (769 Crohn’s disease-CD, 443 ulcerative colitis-UC). Rate of DR was 36.4% (95%-CI: 12.6-69.4%) at eight weeks, 39.1% (95%-CI: 10.4-78%) at six months, 44.4% (95%-CI: 34.6-54.6%) at one year, and 36% (95%-CI: 18.7-58%) at two years. DR in CD at one year was 48.6% (95%-CI: 32.8-64.7%) and in UC was 43.6% (95%-CI: 32.8-55.1%).Conclusions The rate of DR was highest after one year of therapy, in nearly 45% of IBD patients treated with anti-TNFα. Similar rates were achieved between patients with UC and CD. The findings highlight the efficacy of anti-TNFα in real-world setting. Future studies using RWD can determine efficacy of newer IBD therapeutics in routine clinical practice.