![]() It is expected that up to 19% of patients with UC have severe disease at the time of diagnosis. Patients with extensive or severe inflammation may experience acute complications, such as toxic megacolon and severe bleeding. This disease presents a cyclical course, including phases of exacerbation and remission, with a variable degree of intensity. Symptoms of active UC or relapse include bloody diarrhea with or without mucus, abdominal pain and fecal urgency. CD can progress from pure inflammatory lesions to destructive complications such as intestinal perforation, strictures, abscesses and fistula formation, which may result in irreversible bowel damage leading to loss of gastrointestinal tract function and disability that may require hospitalizations and surgical treatment. Most cases, particularly in CD, are moderate to severe at diagnosis, with a tendency for disease activity to fluctuate over time. Patients with IBD frequently present a lifelong relapsing and remitting course that has a negative impact on health and quality of life, often resulting in long-term sequelae. Most of the twenty individual studies retrieved contained a low or very low quality of evidence.Ĭrohn’s disease (CD) and ulcerative colitis (UC) are the two main disease categories of inflammatory bowel disease (IBD), a group of idiopathic chronic inflammatory conditions affecting the digestive system. Two meta-analyses were retrieved evaluating colectomy rates for tacrolimus and cyclosporine in UC. For secondary outcomes, no meta-analyses specifically evaluated fecal calprotectin, hospitalization or death. For induction of mucosal healing, one meta-analysis showed a favorable rate with tacrolimus versus placebo for UC. The clinical response rates for cyclosporine were 41.7% in randomized controlled trials (RCTs) and 55.4% in non-RCTs for UC. Three meta-analyses showed the superiority of tacrolimus vs placebo for induction of clinical response in UC. ![]() AZA and 6-MP had no advantage over placebo in induction of clinical response in CD. ![]() Only one meta-analysis evaluated clinical remission maintenance, showing no statistically significant difference between MTX and placebo, 5-ASA, or 6-MP in UC. For induction of clinical remission, four meta-analyses were selected (AZA and 6-MP showed no advantage over placebo, MTX or 5-ASA in CD MTX showed no statistically significant difference versus placebo, 6-MP, or 5-ASA in UC tacrolimus was superior to placebo for UC in two meta-analyses). The search strategy identified 1995 citations, of which 27 were considered eligible (7 meta-analyses, 20 individual studies). The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria. As secondary outcomes, fecal calprotectin, hospitalization, death, and surgeries were analyzed. ![]() The primary outcome measures were clinical remission (induction or maintenance), clinical response and mucosal healing. The exclusion criteria were sample size below 50 narrative reviews specific subpopulations ( e.g., pregnant women, comorbidities) studies on postoperative IBD and languages other than English, Spanish, French or Portuguese. Corticosteroids (prednisone, hydrocortisone, budesonide, prednisolone, dexamethasone), 5-aminosalicylic acid (5-ASA) derivatives (mesalazine and sulfasalazine) and immunosuppressants were considered conventional therapy. The inclusion criteria encompassed meta-analyses, systematic reviews, randomized clinical trials, observational and case-control studies concerning conventional therapy in adult patients with MS-IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). A systematic review with no time limit was conducted in July 2017 through the Cochrane Collaboration, MEDLINE, and LILACS databases. ![]()
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