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Type I interferons for induction of remission in ulcerative colitis.
Cochrane Database Syst Rev 2008; (3):CD006790CD

Abstract

BACKGROUND

Interferons (IFNs) are cytokines which possess immunoregulatory properties and have been used to successfully treat a number of chronic inflammatory disorders. It has been postulated that Type I IFNs may be able to re-establish the Th1/Th2 balance in Th2 predominant diseases like ulcerative colitis.

OBJECTIVES

To systematically evaluate the efficacy and safety of type I IFN therapy for induction of remission in ulcerative colitis.

SEARCH STRATEGY

The following electronic databases were searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders (IBD/FBD) Group Specialised Trial Register, and http://ClinicalTrials.gov. Reference lists of trials and review articles, as well as recent proceedings from major gastroenterology meetings were manually searched. Contact was made with pharmaceutical companies manufacturing type I IFNs.

SELECTION CRITERIA

Randomised controlled trials of type I IFNs for induction of remission in UC were included. The study population included patients of any age with active ulcerative colitis. There were no exclusions based on type, dose or duration of IFN treatment. The primary outcome was induction of remission of ulcerative colitis. Secondary outcomes included: time to remission, mean change in disease activity index score, clinical, histological or endoscopic improvement, improvement in quality of life, and adverse events.

DATA COLLECTION AND ANALYSIS

Two independent investigators reviewed studies for eligibility, extracted the data and assessed study quality using Jadad's criteria. A random or fixed effects model was chosen based on an assessment of heterogeneity, and studies were weighted using the DerSimonian & Laird or the Mantel-Haenszel method accordingly. Meta-analysis was performed using RevMan 4.2.10 software.

MAIN RESULTS

Four studies were eligible for inclusion. Three studies compared type I IFNs to placebo and a single study compared IFNs to prednisolone enemas in patients with left-sided colitis. Meta-analysis was based on the three IFN-placebo studies. There was no significant benefit of type I IFNs over placebo for inducing remission in ulcerative colitis (RR 1.24; 95% CI 0.81 to 1.90). There were no statistically significant differences in any of the secondary outcome variables.

AUTHORS' CONCLUSIONS

The existing literature does not support the efficacy of type I IFNs for induction of remission in patients with UC. Given concerns regarding the tolerability of IFN therapy, we suggest that the results of two ongoing trials are evaluated for efficacy and safety prior to development or commencement of further randomised controlled trials of type I IFNs in UC.

Authors+Show Affiliations

Mount Sinai Hospital, Room 445, 600 University Ave, Toronto, Ontario, Canada, M5G 1X5. cynthia.seow@utoronto.ca

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

18646167

Citation

Seow, Cynthia H., et al. "Type I Interferons for Induction of Remission in Ulcerative Colitis." The Cochrane Database of Systematic Reviews, 2008, p. CD006790.
Seow CH, Benchimol EI, Griffiths AM, et al. Type I interferons for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2008.
Seow, C. H., Benchimol, E. I., Griffiths, A. M., & Steinhart, A. H. (2008). Type I interferons for induction of remission in ulcerative colitis. The Cochrane Database of Systematic Reviews, (3), p. CD006790. doi:10.1002/14651858.CD006790.pub2.
Seow CH, et al. Type I Interferons for Induction of Remission in Ulcerative Colitis. Cochrane Database Syst Rev. 2008 Jul 16;(3)CD006790. PubMed PMID: 18646167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Type I interferons for induction of remission in ulcerative colitis. AU - Seow,Cynthia H, AU - Benchimol,Eric I, AU - Griffiths,Anne Marie, AU - Steinhart,A Hillary, Y1 - 2008/07/16/ PY - 2008/7/23/pubmed PY - 2008/10/16/medline PY - 2008/7/23/entrez SP - CD006790 EP - CD006790 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Interferons (IFNs) are cytokines which possess immunoregulatory properties and have been used to successfully treat a number of chronic inflammatory disorders. It has been postulated that Type I IFNs may be able to re-establish the Th1/Th2 balance in Th2 predominant diseases like ulcerative colitis. OBJECTIVES: To systematically evaluate the efficacy and safety of type I IFN therapy for induction of remission in ulcerative colitis. SEARCH STRATEGY: The following electronic databases were searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders (IBD/FBD) Group Specialised Trial Register, and http://ClinicalTrials.gov. Reference lists of trials and review articles, as well as recent proceedings from major gastroenterology meetings were manually searched. Contact was made with pharmaceutical companies manufacturing type I IFNs. SELECTION CRITERIA: Randomised controlled trials of type I IFNs for induction of remission in UC were included. The study population included patients of any age with active ulcerative colitis. There were no exclusions based on type, dose or duration of IFN treatment. The primary outcome was induction of remission of ulcerative colitis. Secondary outcomes included: time to remission, mean change in disease activity index score, clinical, histological or endoscopic improvement, improvement in quality of life, and adverse events. DATA COLLECTION AND ANALYSIS: Two independent investigators reviewed studies for eligibility, extracted the data and assessed study quality using Jadad's criteria. A random or fixed effects model was chosen based on an assessment of heterogeneity, and studies were weighted using the DerSimonian & Laird or the Mantel-Haenszel method accordingly. Meta-analysis was performed using RevMan 4.2.10 software. MAIN RESULTS: Four studies were eligible for inclusion. Three studies compared type I IFNs to placebo and a single study compared IFNs to prednisolone enemas in patients with left-sided colitis. Meta-analysis was based on the three IFN-placebo studies. There was no significant benefit of type I IFNs over placebo for inducing remission in ulcerative colitis (RR 1.24; 95% CI 0.81 to 1.90). There were no statistically significant differences in any of the secondary outcome variables. AUTHORS' CONCLUSIONS: The existing literature does not support the efficacy of type I IFNs for induction of remission in patients with UC. Given concerns regarding the tolerability of IFN therapy, we suggest that the results of two ongoing trials are evaluated for efficacy and safety prior to development or commencement of further randomised controlled trials of type I IFNs in UC. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/18646167/Type_I_interferons_for_induction_of_remission_in_ulcerative_colitis_ L2 - https://doi.org/10.1002/14651858.CD006790.pub2 DB - PRIME DP - Unbound Medicine ER -