Effects of Concomitant Immunomodulator Therapy on Efficacy and Safety of Anti-Tumor Necrosis Factor Therapy for Crohn's Disease: A Meta-analysis of Placebo-controlled Trials.
Identifieur interne : 002627 ( PubMed/Corpus ); précédent : 002626; suivant : 002628Effects of Concomitant Immunomodulator Therapy on Efficacy and Safety of Anti-Tumor Necrosis Factor Therapy for Crohn's Disease: A Meta-analysis of Placebo-controlled Trials.
Auteurs : Jennifer L. Jones ; Gilaad G. Kaplan ; Laurent Peyrin-Biroulet ; Leonard Baidoo ; Shane Devlin ; Gil Y. Melmed ; Divine Tanyingoh ; Laura Raffals ; Peter Irving ; Patricia Kozuch ; Miles Sparrow ; Fernando Velayos ; Brian Bressler ; Adam Cheifetz ; Jean-Frederic Colombel ; Corey A. SiegelSource :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [ 1542-7714 ] ; 2015.
English descriptors
- KwdEn :
- Crohn Disease (drug therapy), Drug Therapy, Combination (adverse effects), Drug Therapy, Combination (methods), Drug-Related Side Effects and Adverse Reactions (epidemiology), Drug-Related Side Effects and Adverse Reactions (pathology), Humans, Immunologic Factors (administration & dosage), Immunologic Factors (adverse effects), Placebos (administration & dosage), Randomized Controlled Trials as Topic, Treatment Outcome, Tumor Necrosis Factor-alpha (antagonists & inhibitors).
- MESH :
- chemical , administration & dosage : Immunologic Factors, Placebos.
- adverse effects : Drug Therapy, Combination, Immunologic Factors.
- chemical , antagonists & inhibitors : Tumor Necrosis Factor-alpha.
- drug therapy : Crohn Disease.
- epidemiology : Drug-Related Side Effects and Adverse Reactions.
- methods : Drug Therapy, Combination.
- pathology : Drug-Related Side Effects and Adverse Reactions.
- Humans, Randomized Controlled Trials as Topic, Treatment Outcome.
Abstract
There is debate over whether patients with Crohn's disease who start anti-tumor necrosis factor (TNF) therapy after failed immunomodulator therapy should continue to receive concomitant immunomodulators. We conducted a meta-analysis of subgroups from randomized controlled trials (RCTs) of anti-TNF agents to compare the efficacy and safety of concomitant immunomodulator therapy vs anti-TNF monotherapy.
DOI: 10.1016/j.cgh.2015.06.034
PubMed: 26142167
Links to Exploration step
pubmed:26142167Le document en format XML
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Kaplan</name><affiliation><nlm:affiliation>University of Calgary, Calgary, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Peyrin Biroulet, Laurent" sort="Peyrin Biroulet, Laurent" uniqKey="Peyrin Biroulet L" first="Laurent" last="Peyrin-Biroulet">Laurent Peyrin-Biroulet</name><affiliation><nlm:affiliation>Inserum U954 and Université de Lorraine, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Baidoo, Leonard" sort="Baidoo, Leonard" uniqKey="Baidoo L" first="Leonard" last="Baidoo">Leonard Baidoo</name><affiliation><nlm:affiliation>University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Devlin, Shane" sort="Devlin, Shane" uniqKey="Devlin S" first="Shane" last="Devlin">Shane Devlin</name><affiliation><nlm:affiliation>University of Calgary, Calgary, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Melmed, Gil Y" sort="Melmed, Gil Y" uniqKey="Melmed G" first="Gil Y" last="Melmed">Gil Y. Melmed</name><affiliation><nlm:affiliation>Cedars-Sinai Medical Center, Los Angeles, California.</nlm:affiliation></affiliation></author><author><name sortKey="Tanyingoh, Divine" sort="Tanyingoh, Divine" uniqKey="Tanyingoh D" first="Divine" last="Tanyingoh">Divine Tanyingoh</name><affiliation><nlm:affiliation>University of Calgary, Calgary, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Raffals, Laura" sort="Raffals, Laura" uniqKey="Raffals L" first="Laura" last="Raffals">Laura Raffals</name><affiliation><nlm:affiliation>Mayo Clinic, Rochester, Minnesota.</nlm:affiliation></affiliation></author><author><name sortKey="Irving, Peter" sort="Irving, Peter" uniqKey="Irving P" first="Peter" last="Irving">Peter Irving</name><affiliation><nlm:affiliation>Guy's and St Thomas' Hospitals, London, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Kozuch, Patricia" sort="Kozuch, Patricia" uniqKey="Kozuch P" first="Patricia" last="Kozuch">Patricia Kozuch</name><affiliation><nlm:affiliation>Jefferson University, Philadelphia, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Sparrow, Miles" sort="Sparrow, Miles" uniqKey="Sparrow M" first="Miles" last="Sparrow">Miles Sparrow</name><affiliation><nlm:affiliation>The Alfred Hospital, Melbourne, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Velayos, Fernando" sort="Velayos, Fernando" uniqKey="Velayos F" first="Fernando" last="Velayos">Fernando Velayos</name><affiliation><nlm:affiliation>University of California San Francisco, San Francisco, California.</nlm:affiliation></affiliation></author><author><name sortKey="Bressler, Brian" sort="Bressler, Brian" uniqKey="Bressler B" first="Brian" last="Bressler">Brian Bressler</name><affiliation><nlm:affiliation>University of British Columbia, Vancouver, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Cheifetz, Adam" sort="Cheifetz, Adam" uniqKey="Cheifetz A" first="Adam" last="Cheifetz">Adam Cheifetz</name><affiliation><nlm:affiliation>Beth Israel Deaconess Medical Center, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Colombel, Jean Frederic" sort="Colombel, Jean Frederic" uniqKey="Colombel J" first="Jean-Frederic" last="Colombel">Jean-Frederic Colombel</name><affiliation><nlm:affiliation>Icahn School of Medicine at Mount Sinai, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Siegel, Corey A" sort="Siegel, Corey A" uniqKey="Siegel C" first="Corey A" last="Siegel">Corey A. Siegel</name><affiliation><nlm:affiliation>Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: corey.a.siegel@hitchcock.org.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2015">2015</date><idno type="RBID">pubmed:26142167</idno><idno type="pmid">26142167</idno><idno type="doi">10.1016/j.cgh.2015.06.034</idno><idno type="wicri:Area/PubMed/Corpus">002627</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">002627</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effects of Concomitant Immunomodulator Therapy on Efficacy and Safety of Anti-Tumor Necrosis Factor Therapy for Crohn's Disease: A Meta-analysis of Placebo-controlled Trials.</title><author><name sortKey="Jones, Jennifer L" sort="Jones, Jennifer L" uniqKey="Jones J" first="Jennifer L" last="Jones">Jennifer L. Jones</name><affiliation><nlm:affiliation>Dalhousie University, Halifax, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Kaplan, Gilaad G" sort="Kaplan, Gilaad G" uniqKey="Kaplan G" first="Gilaad G" last="Kaplan">Gilaad G. Kaplan</name><affiliation><nlm:affiliation>University of Calgary, Calgary, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Peyrin Biroulet, Laurent" sort="Peyrin Biroulet, Laurent" uniqKey="Peyrin Biroulet L" first="Laurent" last="Peyrin-Biroulet">Laurent Peyrin-Biroulet</name><affiliation><nlm:affiliation>Inserum U954 and Université de Lorraine, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Baidoo, Leonard" sort="Baidoo, Leonard" uniqKey="Baidoo L" first="Leonard" last="Baidoo">Leonard Baidoo</name><affiliation><nlm:affiliation>University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Devlin, Shane" sort="Devlin, Shane" uniqKey="Devlin S" first="Shane" last="Devlin">Shane Devlin</name><affiliation><nlm:affiliation>University of Calgary, Calgary, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Melmed, Gil Y" sort="Melmed, Gil Y" uniqKey="Melmed G" first="Gil Y" last="Melmed">Gil Y. Melmed</name><affiliation><nlm:affiliation>Cedars-Sinai Medical Center, Los Angeles, California.</nlm:affiliation></affiliation></author><author><name sortKey="Tanyingoh, Divine" sort="Tanyingoh, Divine" uniqKey="Tanyingoh D" first="Divine" last="Tanyingoh">Divine Tanyingoh</name><affiliation><nlm:affiliation>University of Calgary, Calgary, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Raffals, Laura" sort="Raffals, Laura" uniqKey="Raffals L" first="Laura" last="Raffals">Laura Raffals</name><affiliation><nlm:affiliation>Mayo Clinic, Rochester, Minnesota.</nlm:affiliation></affiliation></author><author><name sortKey="Irving, Peter" sort="Irving, Peter" uniqKey="Irving P" first="Peter" last="Irving">Peter Irving</name><affiliation><nlm:affiliation>Guy's and St Thomas' Hospitals, London, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Kozuch, Patricia" sort="Kozuch, Patricia" uniqKey="Kozuch P" first="Patricia" last="Kozuch">Patricia Kozuch</name><affiliation><nlm:affiliation>Jefferson University, Philadelphia, Pennsylvania.</nlm:affiliation></affiliation></author><author><name sortKey="Sparrow, Miles" sort="Sparrow, Miles" uniqKey="Sparrow M" first="Miles" last="Sparrow">Miles Sparrow</name><affiliation><nlm:affiliation>The Alfred Hospital, Melbourne, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Velayos, Fernando" sort="Velayos, Fernando" uniqKey="Velayos F" first="Fernando" last="Velayos">Fernando Velayos</name><affiliation><nlm:affiliation>University of California San Francisco, San Francisco, California.</nlm:affiliation></affiliation></author><author><name sortKey="Bressler, Brian" sort="Bressler, Brian" uniqKey="Bressler B" first="Brian" last="Bressler">Brian Bressler</name><affiliation><nlm:affiliation>University of British Columbia, Vancouver, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Cheifetz, Adam" sort="Cheifetz, Adam" uniqKey="Cheifetz A" first="Adam" last="Cheifetz">Adam Cheifetz</name><affiliation><nlm:affiliation>Beth Israel Deaconess Medical Center, Boston, Massachusetts.</nlm:affiliation></affiliation></author><author><name sortKey="Colombel, Jean Frederic" sort="Colombel, Jean Frederic" uniqKey="Colombel J" first="Jean-Frederic" last="Colombel">Jean-Frederic Colombel</name><affiliation><nlm:affiliation>Icahn School of Medicine at Mount Sinai, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Siegel, Corey A" sort="Siegel, Corey A" uniqKey="Siegel C" first="Corey A" last="Siegel">Corey A. Siegel</name><affiliation><nlm:affiliation>Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: corey.a.siegel@hitchcock.org.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association</title><idno type="eISSN">1542-7714</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Crohn Disease (drug therapy)</term><term>Drug Therapy, Combination (adverse effects)</term><term>Drug Therapy, Combination (methods)</term><term>Drug-Related Side Effects and Adverse Reactions (epidemiology)</term><term>Drug-Related Side Effects and Adverse Reactions (pathology)</term><term>Humans</term><term>Immunologic Factors (administration & dosage)</term><term>Immunologic Factors (adverse effects)</term><term>Placebos (administration & dosage)</term><term>Randomized Controlled Trials as Topic</term><term>Treatment Outcome</term><term>Tumor Necrosis Factor-alpha (antagonists & inhibitors)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Immunologic Factors</term><term>Placebos</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Drug Therapy, Combination</term><term>Immunologic Factors</term></keywords><keywords scheme="MESH" type="chemical" qualifier="antagonists & inhibitors" xml:lang="en"><term>Tumor Necrosis Factor-alpha</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Crohn Disease</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Drug-Related Side Effects and Adverse Reactions</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Drug Therapy, Combination</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Drug-Related Side Effects and Adverse Reactions</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Randomized Controlled Trials as Topic</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">There is debate over whether patients with Crohn's disease who start anti-tumor necrosis factor (TNF) therapy after failed immunomodulator therapy should continue to receive concomitant immunomodulators. We conducted a meta-analysis of subgroups from randomized controlled trials (RCTs) of anti-TNF agents to compare the efficacy and safety of concomitant immunomodulator therapy vs anti-TNF monotherapy.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">26142167</PMID><DateCreated><Year>2015</Year><Month>11</Month><Day>21</Day></DateCreated><DateCompleted><Year>2016</Year><Month>08</Month><Day>19</Day></DateCompleted><DateRevised><Year>2015</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1542-7714</ISSN><JournalIssue CitedMedium="Internet"><Volume>13</Volume><Issue>13</Issue><PubDate><Year>2015</Year><Month>Dec</Month></PubDate></JournalIssue><Title>Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association</Title><ISOAbbreviation>Clin. Gastroenterol. Hepatol.</ISOAbbreviation></Journal><ArticleTitle>Effects of Concomitant Immunomodulator Therapy on Efficacy and Safety of Anti-Tumor Necrosis Factor Therapy for Crohn's Disease: A Meta-analysis of Placebo-controlled Trials.</ArticleTitle><Pagination><MedlinePgn>2233-40.e1-2; quiz e177-8</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.cgh.2015.06.034</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S1542-3565(15)00910-6</ELocationID><Abstract><AbstractText Label="BACKGROUND & AIMS" NlmCategory="OBJECTIVE">There is debate over whether patients with Crohn's disease who start anti-tumor necrosis factor (TNF) therapy after failed immunomodulator therapy should continue to receive concomitant immunomodulators. We conducted a meta-analysis of subgroups from randomized controlled trials (RCTs) of anti-TNF agents to compare the efficacy and safety of concomitant immunomodulator therapy vs anti-TNF monotherapy.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">We performed a systematic review of literature published from 1980 through 2008 and identified 11 RCTs of anti-TNF agents in patients with luminal or fistulizing Crohn's disease. We excluded RCTs of patients who were naive to anti-TNF and immunomodulator therapy. The primary end points were clinical response at weeks 4-14 and 24-30 and remission at weeks 24-30. Secondary end points included infusion site or injection site reactions and selected adverse events. A priori subgroup analyses were performed to evaluate fistula closure and the efficacy and safety of combination therapy with different anti-TNF agents.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Overall, combination therapy was no more effective than monotherapy in inducing 6-month remission (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.80-1.31), inducing a response (OR, 1.08; 95% CI, 0.79-1.48), maintaining a response (OR, 1.53; 95% CI, 0.67-3.49), or inducing partial (OR, 1.25; 95% CI, 0.84-1.88) or complete fistula closure (OR, 1.10; 95% CI, 0.68-1.78). In subgroup analyses of individual anti-TNF agents, combination therapy was not more effective than monotherapy in inducing 6-month remission in those treated with infliximab (OR, 1.73; 95% CI, 0.97-3.07), adalimumab (OR, 0.88; 95% CI, 0.58-1.35), or certolizumab (OR, 0.93; 95% CI, 0.65-1.34). Overall, combination therapy was not associated with an increase in adverse events, but inclusion of infliximab was associated with fewer injection site reactions (OR, 0.46; 95% CI, 0.26-0.79.)</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">On the basis of a meta-analysis, continued use of immunomodulator therapy after starting anti-TNF therapy is no more effective than anti-TNF monotherapy in inducing or maintaining response or remission. RCTs are needed to adequately assess the efficacy of continued immunomodulator therapy after anti-TNF therapy is initiated.</AbstractText><CopyrightInformation>Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Jones</LastName><ForeName>Jennifer L</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Dalhousie University, Halifax, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kaplan</LastName><ForeName>Gilaad G</ForeName><Initials>GG</Initials><AffiliationInfo><Affiliation>University of Calgary, Calgary, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Peyrin-Biroulet</LastName><ForeName>Laurent</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Inserum U954 and Université de Lorraine, Nancy, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baidoo</LastName><ForeName>Leonard</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>University of Pittsburgh, Pittsburgh, Pennsylvania.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Devlin</LastName><ForeName>Shane</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>University of Calgary, Calgary, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Melmed</LastName><ForeName>Gil Y</ForeName><Initials>GY</Initials><AffiliationInfo><Affiliation>Cedars-Sinai Medical Center, Los Angeles, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tanyingoh</LastName><ForeName>Divine</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>University of Calgary, Calgary, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Raffals</LastName><ForeName>Laura</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Mayo Clinic, Rochester, Minnesota.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Irving</LastName><ForeName>Peter</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Guy's and St Thomas' Hospitals, London, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kozuch</LastName><ForeName>Patricia</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Jefferson University, Philadelphia, Pennsylvania.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sparrow</LastName><ForeName>Miles</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>The Alfred Hospital, Melbourne, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Velayos</LastName><ForeName>Fernando</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>University of California San Francisco, San Francisco, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bressler</LastName><ForeName>Brian</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>University of British Columbia, Vancouver, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cheifetz</LastName><ForeName>Adam</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Beth Israel Deaconess Medical Center, Boston, Massachusetts.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Colombel</LastName><ForeName>Jean-Frederic</ForeName><Initials>JF</Initials><AffiliationInfo><Affiliation>Icahn School of Medicine at Mount Sinai, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Siegel</LastName><ForeName>Corey A</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: corey.a.siegel@hitchcock.org.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D017418">Meta-Analysis</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2015</Year><Month>06</Month><Day>30</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Clin Gastroenterol Hepatol</MedlineTA><NlmUniqueID>101160775</NlmUniqueID><ISSNLinking>1542-3565</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007155">Immunologic Factors</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D010919">Placebos</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D014409">Tumor Necrosis Factor-alpha</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D003424" MajorTopicYN="N">Crohn Disease</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D064420" MajorTopicYN="N">Drug-Related Side Effects and Adverse Reactions</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007155" MajorTopicYN="N">Immunologic Factors</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="Y">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010919" MajorTopicYN="N">Placebos</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016032" MajorTopicYN="N">Randomized Controlled Trials as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014409" MajorTopicYN="N">Tumor Necrosis Factor-alpha</DescriptorName><QualifierName UI="Q000037" MajorTopicYN="Y">antagonists & inhibitors</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Clinical Trial</Keyword><Keyword MajorTopicYN="N">IBD</Keyword><Keyword MajorTopicYN="N">Immune Suppression</Keyword><Keyword MajorTopicYN="N">Inflammatory Bowel Disease</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2015</Year><Month>05</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2015</Year><Month>06</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2015</Year><Month>7</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2015</Year><Month>7</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>8</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">26142167</ArticleId><ArticleId IdType="pii">S1542-3565(15)00910-6</ArticleId><ArticleId IdType="doi">10.1016/j.cgh.2015.06.034</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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