***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate the efficacy of certolizumab pegol ( CZP ) in improving endoscopic lesions in patients with active ileocolonic Crohn 's disease ( CD ) . Methods This phase IIIB multicentre open-label clinical trial enrolled 89 adult patients with active endoscopic disease ( ulceration in ≥2 intestinal segments with a Crohn 's Disease Endoscopic Index of Severity ( CDEIS ) score ≥8 points ) . Patients received subcutaneous CZP 400 mg at weeks 0 , 2 and 4 and every 4 weeks up to week 52 . Endoscopic evaluations were performed at weeks 0 , 10 and 54 . The primary outcome was mean change in CDEIS score at week 10 ; secondary outcome measures included endoscopic response ( decrease in CDEIS score > 5 points ) , remission ( CDEIS score < 6 ) , complete remission ( CDEIS score <3 ) and mucosal healing ( no ulcer ) at weeks 10 and 54 . Results In the intention-to-treat population ( n=89 ) the mean±SD CDEIS score was 14.5±5.3 at baseline ; the mean decrease in CDEIS score at week 10 was 5.7 ( 95 % CI 4.6 to 6.8 , p<0.0001 ) . Rates of endoscopic response , endoscopic remission , complete endoscopic remission and mucosal healing at week 10 were 54 % , 37 % , 10 % and 4 % , respectively . At week 54 the corresponding rates were 49 % , 27 % , 14 % and 8 % , respectively . The safety profile was consistent with that of previous CZP trials . Conclusions Following CZP treatment in patients with active CD , endoscopic lesions were improved as shown by the decrease in mean CDEIS score and by endoscopic response and remission rates . These benefits were achieved as early as week 10 and were generally maintained through week 54 . Clinical Trial Registration Number NCT00297648 BACKGROUND & AIMS The aim of this study was to evaluate the usefulness of short-term infliximab combined with azathioprine ( AZA ) or 6-mercaptopurine ( 6-MP ) in steroid-dependent Crohn 's disease patients . METHODS Patients with active disease despite prednisone given for more than 6 months were eligible and were stratified as follows : the failure stratum consisted of patients receiving AZA/6-MP at a stable dose for more than 6 months , and the naive stratum consisted of patients not treated previously with AZA/6-MP . Patients were r and omized to infliximab 5 mg/kg or placebo at weeks 0 , 2 , and 6 . All patients were treated with AZA/6-MP maintained at a stable dose throughout the 52 weeks of the study . The primary end point was remission off steroids at week 24 . RESULTS Among the 113 enrolled patients ( 55 in the failure stratum ) , 57 were assigned to infliximab . At week 24 , the success rate ( intent-to-treat analysis ) was higher in the infliximab group than in the placebo group ( 57 % vs 29 % ; P = .003 ) ; at weeks 12 and 52 , the corresponding rates were 75 % vs 38 % ( P < .001 ) and 40 % vs 22 % ( P = .04 ) , respectively . In each stratum , the success rate was significantly higher in the infliximab group at weeks 12 and 24 , and a trend was found at week 52 . In the failure stratum , only 27 % of the patients in the infliximab group were still in remission off steroids , compared with 52 % in the naive stratum . Steroid resistance was less common and the cumulative dose of prednisone was lower in the infliximab group . CONCLUSIONS Infliximab plus AZA/6-MP is more effective than AZA/6-MP alone in steroid-dependent Crohn 's disease patients Objective The aim of this study was to assess the efficacy and safety of adalimumab ( ADA ) , a recombinant human monoclonal antibody against tumour necrosis factor α ( TNF ) , for the induction of clinical remission in anti-TNF naïve patients with moderately to severely active ulcerative colitis . Methods This 8-week , multicentre , r and omised , double-blind , placebo-controlled study ( NCT00385736 ) , conducted at 94 centres in North America and Europe , enrolled ambulatory adult patients with Mayo score of ≥6 points and endoscopic subscore of ≥2 points despite treatment with corticosteroids and /or immunosuppressants . Under the original study protocol , 186 patients were r and omised ( 1:1 ) to subcutaneous treatment with ADA160/80 ( 160 mg at week 0 , 80 mg at week 2 , 40 mg at weeks 4 and 6 ) or placebo . Subsequently , at the request of European regulatory authorities , the protocol was amended to include a second induction group ( ADA80/40 : 80 mg at week 0 , 40 mg at weeks 2 , 4 and 6 ) . The primary efficacy endpoint was clinical remission ( Mayo score ≤2 with no individual subscore > 1 ) at week 8 , assessed in 390 patients r and omised ( 1:1:1 ) to ADA160/80 , ADA80/40 , or placebo . Safety was assessed in all enrolled patients . Patients , study site personnel , investigators , and the sponsor were blinded to treatment assignment . Results At week 8 , 18.5 % of patients in the ADA160/80 group ( p=0.031 vs placebo ) and 10.0 % in the ADA80/40 group ( p=0.833 vs placebo ) were in remission , compared with 9.2 % in the placebo group . Serious adverse events occurred in 7.6 % , 3.8 % and 4.0 % of patients in the placebo , ADA80/40 , and ADA160/80 groups , respectively . There were two malignancies in the placebo group , none in the ADA groups . There were no cases of tuberculosis and no deaths . Conclusions ADA160/80 was safe and effective for induction of clinical remission in patients with moderately to severely active ulcerative colitis failing treatment with corticosteroids and /or immunosuppressants . Clinical trial NCT00385736 OBJECTIVES : Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn 's disease ( SES-CD ) and noninvasive markers are scarce . The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin , C-reactive protein ( CRP ) , blood leukocytes , and the Crohn 's disease activity index ( CDAI ) . METHODS : Crohn 's disease patients undergoing complete ileocolonoscopy  were prospect ively enrolled and scored independently according to the SES-CD and the CDAI . SES-CD was defined as follows : inactive 0–3 ; mild 4–10 ; moderate 11–19 ; and high ≥20 . RESULTS : Values in CD patients ( n=140 ileocolonoscopies ) compared with controls ( n=43 ) are as follows : calprotectin , 334±322 vs. 18±5 μg/g ; CRP , 26±29 vs. 3±2 mg/l ; and blood leukocytes , 9.1±3.4 vs. 5.4±1.9 g/l ( all P<0.001 ) . The SES-CD correlated closest with calprotectin ( Spearman 's rank correlation coefficient r=0.75 ) , followed by CRP ( r=0.53 ) , blood leukocytes ( r=0.42 ) , and the CDAI ( r=0.38 ) . Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity ( 104±138 vs. 231±244 μg/g , P<0.001 ) , mild from moderate activity ( 231±244 vs. 395±256 μg/g , P=0.008 ) , and moderate from high activity ( 395±256 vs. 718±320 μg/g , P<0.001 ) . The overall accuracy for the detection of endoscopically active disease was 87 % for calprotectin ( cutoff 70 μg/g ) , 66 % for elevated CRP , 54 % for blood leukocytosis , and 40 % for the CDAI ≥150 . CONCLUSIONS : Fecal calprotectin correlated closest with SES-CD , followed by CRP , blood leukocytes , and the CDAI . Furthermore , fecal calprotectin was the only marker that reliably discriminated inactive from mild , moderate , and highly active disease , which underlines its usefulness for activity monitoring Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Adalimumab is a fully human , monoclonal antibody against tumor necrosis factor that is approved in Western countries for the treatment of moderately to severely active ulcerative colitis ( UC ) . Methods This 52-week , phase 2/3 , r and omized , double-blind study evaluated adalimumab for induction and maintenance treatment in 273 anti-TNF – naive Japanese patients with UC who were refractory to corticosteroids , immunomodulators , or both . Patients received placebo , adalimumab 80/40 ( 80 mg at week 0 , then 40 mg every other week ) , or adalimumab 160/80 ( 160/80 mg at weeks 0/2 , then 40 mg every other week ) in addition to background UC therapy . Results At week 8 , remission rates were similar among treatment arms , but more patients treated with adalimumab 160/80 achieved response ( placebo , 35 % ; 80/40 , 43 % ; 160/80 , 50 % ; P = 0.044 for 160/80 vs placebo ) and mucosal healing ( placebo , 30 % ; 80/40 , 39 % ; 160/80 , 44 % ; P = 0.045 for 160/80 vs placebo ) compared with placebo . At week 52 , more patients receiving adalimumab 40 mg every other week achieved response ( 18 vs 31 % ; P = 0.021 ) , remission ( 7 vs 23 % ; P = 0.001 ) , and mucosal healing ( 16 vs 29 % ; P = 0.015 ) compared with placebo . Week 8 response to adalimumab was associated with greater rates of response ( 61 % ) , remission ( 46 % ) , and mucosal healing ( 57 % ) at week 52 relative to the overall population . Rates of serious adverse events were similar between treatment arms . Conclusions Induction with adalimumab 160/80 mg led to early response and mucosal healing . Maintenance adalimumab had greater rates of long-term response , remission , and mucosal healing compared with placebo . No new safety signals were identified BACKGROUND The comparative efficacy and safety of infliximab and azathioprine therapy alone or in combination for Crohn 's disease are unknown . METHODS In this r and omized , double-blind trial , we evaluated the efficacy of infliximab monotherapy , azathioprine monotherapy , and the two drugs combined in 508 adults with moderate-to-severe Crohn 's disease who had not undergone previous immunosuppressive or biologic therapy . Patients were r and omly assigned to receive an intravenous infusion of 5 mg of infliximab per kilogram of body weight at weeks 0 , 2 , and 6 and then every 8 weeks plus daily oral placebo capsules ; 2.5 mg of oral azathioprine per kilogram daily plus a placebo infusion on the st and ard schedule ; or combination therapy with the two drugs . Patients received study medication through week 30 and could continue in a blinded study extension through week 50 . RESULTS Of the 169 patients receiving combination therapy , 96 ( 56.8 % ) were in corticosteroid-free clinical remission at week 26 ( the primary end point ) , as compared with 75 of 169 patients ( 44.4 % ) receiving infliximab alone ( P=0.02 ) and 51 of 170 patients ( 30.0 % ) receiving azathioprine alone ( P<0.001 for the comparison with combination therapy and P=0.006 for the comparison with infliximab ) . Similar numerical trends were found at week 50 . At week 26 , mucosal healing had occurred in 47 of 107 patients ( 43.9 % ) receiving combination therapy , as compared with 28 of 93 patients ( 30.1 % ) receiving infliximab ( P=0.06 ) and  
    Output:
    
There was no statistically significant pairwise difference between vedolizumab and anti-TNF agents in UC .
CONCLUSIONS Anti-TNF and anti-integrin biological agents are effective in inducing mucosal healing in UC , with adalimumab being inferior to infliximab or combination therapy .
Infliximab and adalimumab were similar in CD