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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Forest plot of comparison: 3 Probiotics vs Placebo, outcome: 3.1 Clinical Recurrence.
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Figure 2

Forest plot of comparison: 3 Probiotics vs Placebo, outcome: 3.1 Clinical Recurrence.

Forest plot of comparison: 3 Probiotics vs Placebo, outcome: 3.3 Severe endoscopic recurrence.
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Figure 3

Forest plot of comparison: 3 Probiotics vs Placebo, outcome: 3.3 Severe endoscopic recurrence.

Forest plot of comparison: 3 Probiotics vs Placebo, outcome: 3.2 Any endoscopic recurrence.
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Figure 4

Forest plot of comparison: 3 Probiotics vs Placebo, outcome: 3.2 Any endoscopic recurrence.

Forest plot of comparison: 5 Nitroimidazole vs Placebo, outcome: 5.1 Severe Endoscopic Recurrence (3months).
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Figure 5

Forest plot of comparison: 5 Nitroimidazole vs Placebo, outcome: 5.1 Severe Endoscopic Recurrence (3months).

Forest plot of comparison: 5 Nitroimidazole vs Placebo, outcome: 5.2 Clinical Recurrence (1 year).
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Figure 6

Forest plot of comparison: 5 Nitroimidazole vs Placebo, outcome: 5.2 Clinical Recurrence (1 year).

Forest plot of comparison: 2 Nitroimidazole vs Placebo, outcome: 2.3 Patient Withdrawal.
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Figure 7

Forest plot of comparison: 2 Nitroimidazole vs Placebo, outcome: 2.3 Patient Withdrawal.

Forest plot of comparison: 1 5‐ASA vs Placebo, outcome: 1.1 Clinical Recurrence within 12 months.
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Figure 8

Forest plot of comparison: 1 5‐ASA vs Placebo, outcome: 1.1 Clinical Recurrence within 12 months.

Forest plot of comparison: 1 5‐ASA vs Placebo, outcome: 1.2 Any endoscopic recurrence within 12 months.
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Figure 9

Forest plot of comparison: 1 5‐ASA vs Placebo, outcome: 1.2 Any endoscopic recurrence within 12 months.

Forest plot of comparison: 1 5‐ASA vs Placebo, outcome: 1.3 Severe (score>/=3) endoscopic recurrence within 12 months.
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Figure 10

Forest plot of comparison: 1 5‐ASA vs Placebo, outcome: 1.3 Severe (score>/=3) endoscopic recurrence within 12 months.

Forest plot of comparison: 2 5‐ASA vs Azathioprine/6MP, outcome: 2.1 Clinical Recurrence within 12 months.
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Figure 11

Forest plot of comparison: 2 5‐ASA vs Azathioprine/6MP, outcome: 2.1 Clinical Recurrence within 12 months.

Forest plot of comparison: 2 5‐ASA vs Azathioprine/6MP, outcome: 2.2 Any endoscopic recurrence within 12 months.
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Figure 12

Forest plot of comparison: 2 5‐ASA vs Azathioprine/6MP, outcome: 2.2 Any endoscopic recurrence within 12 months.

Forest plot of comparison: 2 5‐ASA vs Azathioprine/6MP, outcome: 2.3 Severe (>/=3 score) within 12 months.
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Figure 13

Forest plot of comparison: 2 5‐ASA vs Azathioprine/6MP, outcome: 2.3 Severe (>/=3 score) within 12 months.

Forest plot of comparison: 5 Azathioprine/6MP vs placebo, outcome: 5.1 Clinical recurrence at 12 months.
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Figure 14

Forest plot of comparison: 5 Azathioprine/6MP vs placebo, outcome: 5.1 Clinical recurrence at 12 months.

Forest plot of comparison: 5 Azathioprine/6MP vs placebo, outcome: 5.2 Severe endoscopic recurrence (score>/=2) at 12 months.
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Figure 15

Forest plot of comparison: 5 Azathioprine/6MP vs placebo, outcome: 5.2 Severe endoscopic recurrence (score>/=2) at 12 months.

Forest plot of comparison: 4 Budesonide vs Placebo, outcome: 4.1 Severe Endoscopic Recurrence (12 months).
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Figure 16

Forest plot of comparison: 4 Budesonide vs Placebo, outcome: 4.1 Severe Endoscopic Recurrence (12 months).

Forest plot of comparison: 6 Azathioprine/6MP versus other interventions (5ASA or placebo), outcome: 6.1 Clinical recurrence at 12 months.
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Figure 17

Forest plot of comparison: 6 Azathioprine/6MP versus other interventions (5ASA or placebo), outcome: 6.1 Clinical recurrence at 12 months.

Forest plot of comparison: 6 Azathioprine/6MP versus other interventions (5ASA or placebo), outcome: 6.2 Severe endoscopic recurrence (score>/=2) at 12 months.
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Figure 18

Forest plot of comparison: 6 Azathioprine/6MP versus other interventions (5ASA or placebo), outcome: 6.2 Severe endoscopic recurrence (score>/=2) at 12 months.

Comparison 1 Probiotics vs Placebo, Outcome 1 Clinical Recurrence.
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Analysis 1.1

Comparison 1 Probiotics vs Placebo, Outcome 1 Clinical Recurrence.

Comparison 1 Probiotics vs Placebo, Outcome 2 Any Endoscopic Recurrence.
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Analysis 1.2

Comparison 1 Probiotics vs Placebo, Outcome 2 Any Endoscopic Recurrence.

Comparison 1 Probiotics vs Placebo, Outcome 3 Severe Endoscopic Recurrence.
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Analysis 1.3

Comparison 1 Probiotics vs Placebo, Outcome 3 Severe Endoscopic Recurrence.

Comparison 1 Probiotics vs Placebo, Outcome 4 Patient Withdrawal.
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Analysis 1.4

Comparison 1 Probiotics vs Placebo, Outcome 4 Patient Withdrawal.

Comparison 1 Probiotics vs Placebo, Outcome 5 Serious Adverse Events.
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Analysis 1.5

Comparison 1 Probiotics vs Placebo, Outcome 5 Serious Adverse Events.

Comparison 2 Nitroimidazole vs Placebo, Outcome 1 Clinical Recurrence (12 months).
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Analysis 2.1

Comparison 2 Nitroimidazole vs Placebo, Outcome 1 Clinical Recurrence (12 months).

Comparison 2 Nitroimidazole vs Placebo, Outcome 2 Severe (score >/=2) Endoscopic Recurrence (3months).
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Analysis 2.2

Comparison 2 Nitroimidazole vs Placebo, Outcome 2 Severe (score >/=2) Endoscopic Recurrence (3months).

Comparison 2 Nitroimidazole vs Placebo, Outcome 3 Patient Withdrawal.
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Analysis 2.3

Comparison 2 Nitroimidazole vs Placebo, Outcome 3 Patient Withdrawal.

Comparison 2 Nitroimidazole vs Placebo, Outcome 4 Serious Adverse Events.
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Analysis 2.4

Comparison 2 Nitroimidazole vs Placebo, Outcome 4 Serious Adverse Events.

Comparison 3 5‐ASA vs Placebo, Outcome 1 Clinical Recurrence (at study completion).
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Analysis 3.1

Comparison 3 5‐ASA vs Placebo, Outcome 1 Clinical Recurrence (at study completion).

Comparison 3 5‐ASA vs Placebo, Outcome 2 Any Endoscopic Recurrence (at study completion).
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Analysis 3.2

Comparison 3 5‐ASA vs Placebo, Outcome 2 Any Endoscopic Recurrence (at study completion).

Comparison 3 5‐ASA vs Placebo, Outcome 3 Severe (score>/=3) Endoscopic Recurrence (at study completion).
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Analysis 3.3

Comparison 3 5‐ASA vs Placebo, Outcome 3 Severe (score>/=3) Endoscopic Recurrence (at study completion).

Comparison 3 5‐ASA vs Placebo, Outcome 4 Patient Withdrawal.
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Analysis 3.4

Comparison 3 5‐ASA vs Placebo, Outcome 4 Patient Withdrawal.

Comparison 3 5‐ASA vs Placebo, Outcome 5 Serious Adverse Events.
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Analysis 3.5

Comparison 3 5‐ASA vs Placebo, Outcome 5 Serious Adverse Events.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 1 Clinical Recurrence within 12 months.
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Analysis 4.1

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 1 Clinical Recurrence within 12 months.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 2 Clinical recurrence within 24 months.
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Analysis 4.2

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 2 Clinical recurrence within 24 months.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 3 Any endoscopic recurrence (score >/=1) within 12 months.
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Analysis 4.3

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 3 Any endoscopic recurrence (score >/=1) within 12 months.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 4 Severe endoscopic recurrence (score >/=2) within 12 months.
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Analysis 4.4

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 4 Severe endoscopic recurrence (score >/=2) within 12 months.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 5 Very Severe endoscopic recurrence (score >/=3) within 12 months.
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Analysis 4.5

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 5 Very Severe endoscopic recurrence (score >/=3) within 12 months.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 6 Patient Withdrawal.
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Analysis 4.6

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 6 Patient Withdrawal.

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 7 Serious Adverse Events.
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Analysis 4.7

Comparison 4 5‐ASA vs Azathioprine/6MP, Outcome 7 Serious Adverse Events.

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 1 Clinical Recurrence at 12 months.
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Analysis 5.1

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 1 Clinical Recurrence at 12 months.

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 2 Severe Endoscopic Recurrence (score>/=2) at 12 months.
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Analysis 5.2

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 2 Severe Endoscopic Recurrence (score>/=2) at 12 months.

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 3 Patient Withdrawal.
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Analysis 5.3

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 3 Patient Withdrawal.

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 4 Serious Adverse Events.
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Analysis 5.4

Comparison 5 Azathioprine/6MP vs Placebo, Outcome 4 Serious Adverse Events.

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 1 Clinical Recurrence at 12 months.
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Analysis 6.1

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 1 Clinical Recurrence at 12 months.

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 2 Severe Endoscopic Recurrence (score>/=2) at 12 months.
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Analysis 6.2

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 2 Severe Endoscopic Recurrence (score>/=2) at 12 months.

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 3 Patient Withdrawal.
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Analysis 6.3

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 3 Patient Withdrawal.

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 4 Serious Adverse Events.
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Analysis 6.4

Comparison 6 Azathioprine/6MP versus Other Intervention (5ASA or placebo), Outcome 4 Serious Adverse Events.

Comparison 7 Budesonide vs Placebo, Outcome 1 Severe Endoscopic Recurrence (12 months).
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Analysis 7.1

Comparison 7 Budesonide vs Placebo, Outcome 1 Severe Endoscopic Recurrence (12 months).

Comparison 7 Budesonide vs Placebo, Outcome 2 Patient Withdrawal.
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Analysis 7.2

Comparison 7 Budesonide vs Placebo, Outcome 2 Patient Withdrawal.

Comparison 7 Budesonide vs Placebo, Outcome 3 Serious Adverse Events.
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Analysis 7.3

Comparison 7 Budesonide vs Placebo, Outcome 3 Serious Adverse Events.

Comparison 1. Probiotics vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical Recurrence Show forest plot

3

213

Risk Ratio (M‐H, Fixed, 95% CI)

1.41 [0.59, 3.36]

2 Any Endoscopic Recurrence Show forest plot

3

213

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.74, 1.29]

3 Severe Endoscopic Recurrence Show forest plot

4

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.58, 1.58]

4 Patient Withdrawal Show forest plot

3

213

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.65, 1.75]

5 Serious Adverse Events Show forest plot

3

213

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.35, 1.52]

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Comparison 1. Probiotics vs Placebo
Comparison 2. Nitroimidazole vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical Recurrence (12 months) Show forest plot

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.09, 0.57]

2 Severe (score >/=2) Endoscopic Recurrence (3months) Show forest plot

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.44 [0.26, 0.74]

3 Patient Withdrawal Show forest plot

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [1.37, 6.58]

4 Serious Adverse Events Show forest plot

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

2.39 [1.54, 3.70]

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Comparison 2. Nitroimidazole vs Placebo
Comparison 3. 5‐ASA vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical Recurrence (at study completion) Show forest plot

4

652

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.62, 0.94]

2 Any Endoscopic Recurrence (at study completion) Show forest plot

4

615

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.76, 1.13]

3 Severe (score>/=3) Endoscopic Recurrence (at study completion) Show forest plot

3

297

Risk Ratio (M‐H, Random, 95% CI)

0.50 [0.29, 0.84]

4 Patient Withdrawal Show forest plot

5

788

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.89, 1.39]

5 Serious Adverse Events Show forest plot

5

788

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.62, 1.66]

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Comparison 3. 5‐ASA vs Placebo
Comparison 4. 5‐ASA vs Azathioprine/6MP

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical Recurrence within 12 months Show forest plot

4

349

Risk Ratio (M‐H, Fixed, 95% CI)

1.43 [0.95, 2.16]

2 Clinical recurrence within 24 months Show forest plot

3

270

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.95, 1.81]

3 Any endoscopic recurrence (score >/=1) within 12 months Show forest plot

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [1.03, 2.06]

4 Severe endoscopic recurrence (score >/=2) within 12 months Show forest plot

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [0.94, 2.29]

5 Very Severe endoscopic recurrence (score >/=3) within 12 months Show forest plot

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [0.63, 3.79]

6 Patient Withdrawal Show forest plot

3

268

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.59, 1.26]

7 Serious Adverse Events Show forest plot

4

347

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.30, 0.89]

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Comparison 4. 5‐ASA vs Azathioprine/6MP
Comparison 5. Azathioprine/6MP vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical Recurrence at 12 months Show forest plot

2

168

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.38, 0.92]

2 Severe Endoscopic Recurrence (score>/=2) at 12 months Show forest plot

2

168

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.44, 0.92]

3 Patient Withdrawal Show forest plot

2

168

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.51, 1.00]

4 Serious Adverse Events Show forest plot

2

168

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [0.71, 3.66]

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Comparison 5. Azathioprine/6MP vs Placebo
Comparison 6. Azathioprine/6MP versus Other Intervention (5ASA or placebo)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical Recurrence at 12 months Show forest plot

5

480

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.45, 0.92]

2 Severe Endoscopic Recurrence (score>/=2) at 12 months Show forest plot

3

291

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.49, 0.93]

3 Patient Withdrawal Show forest plot

4

389

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.69, 1.26]

4 Serious Adverse Events Show forest plot

5

468

Risk Ratio (M‐H, Fixed, 95% CI)

1.87 [1.16, 3.02]

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Comparison 6. Azathioprine/6MP versus Other Intervention (5ASA or placebo)
Comparison 7. Budesonide vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe Endoscopic Recurrence (12 months) Show forest plot

2

212

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.50, 1.49]

2 Patient Withdrawal Show forest plot

2

212

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.80, 1.86]

3 Serious Adverse Events Show forest plot

2

212

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.37, 2.78]

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Comparison 7. Budesonide vs Placebo