Bacillus Calmette Guerin (BCG) Vaccine for Inducing and Maintaining Remission in Crohn's Disease: A Systematic Review

Objectives: Bacillus Calmette Guerin (BCG) vaccine may act as an immune stimulant. The aim of this review was to systematically assess the efficacy and safety of BCG vaccine for induction and maintenance of remission in CD. Methods: A systematic search was performed to identify randomized controlled trials examining the effect of BCG vaccine for induction and maintaining remission of CD among adult patients. Risk ratio (RR) for inducing and maintaining remission of CD, 95% confidence interval (CI) and P value were calculated using the Mantel-Haenszel method. Results and Discussion: Only one study fulfilled the inclusion criteria for induction of remission of active CD. The study compared oral BCG vaccine versus placebo for active CD. RR for induction of remission was 0.40 (95% CI: 0.05-2.98). One study fulfilled inclusion criteria for maintaining remission. Nineteen patients in each arm completed the study to the end of 12 months. RR for maintaining remission was 0.46 (95% CI: 0.14- 1.59). The evidence was graded as of high or unclear risk of bias. Conclusion: Although, the current evidence does not support the use of BCG vaccine in induction or maintenance of remission for CD, further studies are required because of the non-significant reductions seen.