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Biologics versus Immunomodulators or Antibiotics for the Management of Fistulizing Crohn’s Disease: A Review of Comparative Clinical Effectiveness and Cost-Effectiveness

Last updated: March 29, 2019
Project Number: RC1107-000 - RD0051-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of biologics (with or without concomitant immunomodulators or antibiotics) compared with immunomodulators or antibiotics for the management of fistulizing Crohn’s disease?
  2. What is the cost-effectiveness of biologics (with or without concomitant immunomodulators) compared with immunomodulators or antibiotics for the management of fistulizing Crohn’s disease?

Key Message

Three relevant systematic reviews, one randomized controlled trial, and one economic evaluation were identified regarding the clinical and cost-effectiveness of biologics compared with immunomodulators or antibiotics for the management of fistulizing Crohn’s disease.Evidence of limited quality from one randomized controlled trial suggested that treatment with infliximab is likely effective for improving measures of Crohn’s disease activity and fistula status compared to treatment with conventional therapy (azathioprine and methylprednisolone) following 30 weeks of treatment. Three systematic reviews of economic studies (that included two unique relevant primary studies) and one additional economic evaluation reported mixed findings on the cost-effectiveness of biologics versus immunomodulators or antibiotics for the management of fistulizing Crohn’s disease. Two of the primary studies concluded that biologics were cost-effective compared to various non-biologic treatments; however, one primary study suggested that infliximab was not cost-effective compared to treatment with 6-mercaptopurine and metronidazole.Given the limited availability of relevant literature and the methodological limitations of the reviewed studies (e.g., lack of blinding, the low number of included participants), the effectiveness of biologics compared with immunomodulators or antibiotics for the treatment of fistulizing Crohn’s disease remains uncertain.