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Abstract：
Surgery is a vital pillar in the management of Crohn\'s disease and medical options for prevention of recurrence after surgery are a key consideration. The main classes of effective induction therapies have very different efficacy data for maintenance and this is more pronounced in the postsurgical setting. In this review article, the up-to-date Cochrane reviews on the topic are presented, including a network meta-analysis. The Cochrane evidence shows a high relapse rate in the first 5 years after surgery with placebo or no treatment. The reviews demonstrate that 5-aminosalicylic acid (5-ASA) agents are probably more effective than placebo on pairwise and network meta-analysis, with moderate certainty evidence of a number needed to treat (NNT) of 13. The Cochrane evidence demonstrates that adalimumab may be more effective than placebo on pairwise and network meta-analysis, with low certainty evidence of an NNT of 2. Thiopurine analogues may be effective on pairwise analysis, but may not be effective on network meta-analysis. There was no evidence to support the use of any other agent but these findings are of low and very low certainty. It is proposed that clinicians should consider adalimumab, 5-ASA and thiopurine analogue agents based on the findings of the Cochrane synthesis. The use of the evidence, including the Grading of Recomendations, Assessment, Development, and Evaluations (GRADE) certainty and magnitude of effect data, can support discussions with patients. Future research is needed to consider other therapies that are effective in medically induced maintenance given the low certainty of evidence limiting conclusions, either supporting or refuting their use.
摘要：
手术是治疗克罗恩病的重要支柱，预防手术后复发的药物选择是一个关键的考虑因素。有效的诱导疗法的主要类别具有非常不同的维持功效数据，这在手术后环境中更为明显。在这篇评论文章中，介绍了Cochrane关于该主题的最新评论，包括网络荟萃分析。Cochrane证据显示，在接受安慰剂或不接受治疗的手术后的前5年内，复发率很高。综述表明，5-氨基水杨酸（5-ASA）药物在成对和网络荟萃分析中可能比安慰剂更有效。中等确定性证据表明需要治疗的数量（NNT）为13。Cochrane的证据表明，阿达木单抗在成对和网络荟萃分析中可能比安慰剂更有效。NNT为2的低确定性证据。硫嘌呤类似物可能对配对分析有效，但在网络荟萃分析中可能无效。没有证据支持使用任何其他药物，但这些发现的确定性很低。建议临床医生考虑阿达木单抗，基于Cochrane合成发现的5-ASA和硫嘌呤类似物试剂。证据的使用，包括推荐的分级，评估,发展,以及效果数据的评估(等级)确定性和幅度，可以支持与患者的讨论。未来的研究需要考虑其他治疗是有效的医学诱导的维持证据的低确定性限制的结论，支持或驳斥他们的使用。
