An Evidence-Based Systematic Review on Medical Therapies for Inflammatory Bowel Disease

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory disorders of the gastrointestinal tract. Collectively they are termed inflammatory bowel disease (IBD) and it is estimated that 1. 5 million Americans (1) suffer from UC and CD. Their etiologies are unknown, although both are thought to arise from a disordered immune response to the gut contents in genetically predisposed individuals (1). The characteristics of the inflammatory response are different, with CD typically causing transmural inflammation and occasionally associated with granulomas, whereas in UC the inflammation is usually confined to the mucosa. Both UC and CD exhibit a relapsing and remitting course and there is a significant, often dramatic, reduction in quality of life during exacerbations of the disease (2). This has an impact on psychological health, with active IBD patients experiencing greater levels of distress and feelings of lack of sense of self-control compared with the normal population and patients with inactive IBD (3, 4). Extrapolation from US administrative claims databases suggests that IBD is responsible for 2. 3 million physician visits (5), 180, 000 hospital admissions (6), and costs 6. 3 billion (7) annually. There have been recent guidelines on the management of both UC (8) and CD (9) that direct the clinician on diagnosis and treatment. Approximately 33% of the cost of IBD is due to medical therapy (7), and given the substantial clinical burden and economic cost of IBD it is important to establish the effectiveness of current medical therapies in both UC and CD. Although there have been several systematic reviews on the efficacy of therapy (10, 11), this is a rapidly changing field and there is a need for a comprehensive review of the literature. The American College of Gastroenterology IBD Task Force developed a protocol for systematically reviewing the data on currently available therapies for UC and CD, both in inducing remission and in preventing relapse of the disease. 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