Summers 1979.
Methods | Two independent, randomized, double‐blind, placebo‐controlled trial with patients from 14 centres Part 1, phase 1: 17 week, 4 arm Part 1, phase 2: extends phase 1 out to 1 or 2 years, 4 arm Part 2: 1‐2 years, 4 arm |
|
Participants | N = 604, patients with typical histology of bowel resection or typical appearance of Crohn's on barium x‐ray examination Patients analysed N = 569 Part 1, phase 1: patients with radiologically and clinically active Crohn's disease, n = 295 (placebo n = 77; sulfasalazine n = 74; prednisone n = 85; AZA n = 59) Part I, phase 2: patients from Part 1, Phase 1 who achieved a CDAI <150 after 17 weeks; n = 86 (placebo n = 20; sulfasalazine n = 19; prednisone n = 28; AZA n = 19) Part 2: Patients with inactive disease (CDAI <150) established by medical (n = 226) or surgical intervention (n = 48); n = 274 (placebo n = 101; sulfasalazine n = 58; prednisone n = 61; AZA n = 54) |
|
Interventions |
Part 1 Daily Dosing: Prednisone: CDAI < 150 = 0.25 mg/kg; CDAI = 150‐300 = 0.5 mg/kg; CDAI > 300 = 0.75 mg/kg Sulphasalazine: 1 g/15 kg AZA: 2.5 mg/kg Placebo Part 2 Daily Dosing: Prednisone: CDAI = 150‐300 = 0.25 mg/kg Sulphasalazine: 0.5 g/15 kg AZA: 1 mg/kg Placebo |
|
Outcomes | Part 1, phase 1: induction of remission, efficacy of sulphasalazine, prednisone or AZA versus placebo in patients with active disease. Patients that entered remission (CDAI < 150) with no radiographic progression entered phase 2 Part I, phase 2: maintenance of remission using the same medications to which the patients were assigned in phase 1 Part 2: maintenance of remission after remission was induced medically or with surgical resection within the year before study entry |
|
Notes | Cumulative dose: 612.5 mg/kg for part I phase 2; 364 mg/kg for part 2 Data from Part 2 censored at 1 year | |
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Unclear risk | Not described |
Allocation concealment (selection bias) | Low risk | Centralized randomization |
Blinding (performance bias and detection bias) All outcomes | Low risk | Double‐blinded, identically matched "all prepared in uncoated tablets of identical external and internal appearance" |
Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Attrition appears to be low (possible secondary to the fact that reasons for exiting the study were included in the "Outcome Ranking Scheme") A subset of patients were randomized and then excluded after study completion (justification was wrong diagnosis or inappropriate entry) |
Selective reporting (reporting bias) | Low risk | All outcomes described for each part and phase were reported |
Other bias | Low risk | The study appears to be free of other sources of bias |