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.

中文翻译：

---

克罗恩病术后维持缓解：我们可以从 Cochrane 学到什么？

手术是克罗恩病治疗的重要支柱，预防手术后复发的医疗选择是一个关键考虑因素。主要类型的有效诱导疗法具有非常不同的维持疗效数据，这在术后环境中更为明显。在这篇综述文章中，介绍了关于该主题的最新 Cochrane 综述，包括网络荟萃分析。 Cochrane 证据显示，使用安慰剂或不进行治疗的手术后 5 年内复发率很高。综述表明，在配对和网络荟萃分析中，5-氨基水杨酸 (5-ASA) 药物可能比安慰剂更有效，中等确定性证据表明需要治疗的人数 (NNT) 为 13。Cochrane 证据表明，阿达木单抗在配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。硫嘌呤类似物可能在配对分析中有效，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且非常低。建议临床医生根据 Cochrane 合成的结果考虑使用阿达木单抗、5-ASA 和硫嘌呤类似物药物。证据的使用，包括建议分级、评估、制定和评价 (GRADE) 确定性和效果数据的大小，可以支持与患者的讨论。鉴于支持或反驳其使用的证据质量较低限制了结论，未来的研究需要考虑对药物诱导维持有效的其他疗法。