DEFINED-FORMULA DIETS VERSUS STEROIDS IN THE TREATMENT OF ACTIVE CROHNS-DISEASE - A METAANALYSIS

Background: To compare the effectiveness of defined-formula diets vers us steroids for the treatment of active Crohn's disease, we conducted a meta-analysis of the published clinical trials. Methods: Standard te chniques for literature search were used to identify the pertinent tri als. All studies included in our meta-analysis (n = 7) were aimed at c omparing defined-formula diets versus steroids, using a randomized des ign. The patient-specific end-point of the meta-analysis was the occur rence of a treatment failure. Results: Our meta-analysis indicated tha t steroids are more effective than defined-formula diets for inducing remission in active Crohn's disease. In fact, the relative risk of tre atment failure (RTF) was significantly lower in the steroid group than in the diet group (risk values for patients given steroids compared w ith patients given diet: a) method of Mantel-Haenszel: RTF = 0.35; 95% confidence interval, 0.23-0.53; p < 0.001; b) method of Der Simonian & Laird: RTF = 0.43; 95% confidence interval, <0-0.94; p = 0.03). A se parate analysis was carried out in which only the subgroup of patients who were not intolerant to diet were evaluated; this analysis also sh owed a superiority of steroids over diet. Conclusions: The data examin ed in this meta-analysis do not support the use of diets as primary tr eatment for acute exacerbations of Crohn's disease in adults.