Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Summary Background There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim To perform a systematic review and meta‐analysis to assess the impact of early biologic use in the treatment of CD. Methods PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top‐down) was compared with a conventional step‐up strategy. Random‐effects meta‐analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top‐down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step‐up treatment strategy). Results A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow‐up of 64 weeks (range 10‐416). Meta‐analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI: 1.69‐2.60], n = 2763, P < .00001), lower relapse rates (OR 0.31 [95% CI: 0.14‐0.68], n = 596, P = .003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78‐3.16], n = 994, P < .00001) compared with late/conventional management. Conclusions Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real‐world settings.