Table 6.
GRADE Evidence Profile comparing thiopurines vs. no thiopurines for achieving steroid-free remission, and preventing relapse in patients with steroid-dependent moderate to severe ulcerative colitis
|
Thiopurines COMPARED TO No Thiopurines FOR MODERATE TO SEVERE ULCERATIVE COLITIS | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Study event rates (95% CI) | Relative effect (95% CI) | Absolute effect* | No of participants (studies) | Quality of the evidence (GRADE) | |
| Achieving clinical remission (CRITICAL) | 54/97 (55.7%) | 72/105 (68.6%) | RR 1.25 (1.01 to 1.56) | 139 more per 1,000 (from 6 more to 213 more) | 203 (5 RCTs) | ⨁◯◯◯1,2,3 VERY LOW |
| Relapse after achieving remission (CRITICAL) | 90/146 (61.6%) | 59/157 (37.6%) | RR 0.61 (0.49 to 0.77) | 240 fewer per 1,000 (from 314 fewer to 142 more) | 303 (7 RCTs) | ⨁⨁◯◯1,3 LOW |
|
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1
Rated down for risk of bias (inadequate blinding)
2
Rated down for indirectness (not truly induction of remission, since majority of patients received corticosteroids for inducing remission; outcomes in 1/5 trials not standardized)
3
Rated down for imprecision due to low event rate