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. 2011 Dec 31;7(6):1000-12.
doi: 10.5114/aoms.2011.26612. Epub 2011 Dec 30.

A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease

Solmaz Ehteshami-Afshar  1 , Shekoufeh Nikfar, Ali Rezaie, Mohammad Abdollahi
Affiliations

A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease

Solmaz Ehteshami-Afshar et al. Arch Med Sci. .

Abstract

Introduction: Use of biological therapies may reduce or delay the surgical procedures in patients with inflammatory bowel disease (IBD). The aim of this meta-analysis and systematic review was to determine the impact of pre-operative infliximab (IFX) use on the rate of surgical interventions in patients with IBD and also the effect of preoperative IFX therapy on post-surgical complications.

Material and methods: Literature was searched for studies that investigated the efficacy of IFX on the rate of colectomy and post-operative complications/side effects in patients with IBD between 1966 and February 2011.

Results: Twelve articles were included in the meta-analysis. In comparison to control groups, patients who received IFX had a relative risk (RR) of 1.17 (p = 0.65) for the rate of colectomy, odds ratio of 3.34 (p = 0.09) in seven observational studies and RR of 0.74 (p = 0.79) in clinical trials for mortality. Summary RR of hospitalization was 0.61 (p = 0.005). Infections and anastomotic leak, pouch-related complications, sepsis and thrombotic events were more common in the patients under IFX therapy but post-operational hospitalization was lower. The patients with IBD who were under IFX therapy were most of the times refractive to other therapies and their disease was more severe.

Conclusions: Although IFX does not decrease the rate of colectomy in patients with IBD, it would not increase most of the post-operational side effects in the patients.

Keywords: anti-TNF; colectomy; inflammatory bowel disease; infliximab; meta-analysis; post-operative complications; systematic review.

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Figures

Figure 1
Figure 1
Flow diagram of the study selection process
Figure 2 A
Figure 2 A
Individual and pooled relative risk for the outcome of “colectomy” in the clinical trials considering IFX vs. placebo therapy
Figure 2 B
Figure 2 B
Heterogeneity indicators for the outcome of “colectomy” in the clinical trials considering IFX vs. placebo therapy
Figure 3 A-a
Figure 3 A-a
Individual and pooled odds ratio for the outcome of “mortality” in the observational studies considering IFX vs. placebo therapy
Figure 3 A-b
Figure 3 A-b
Heterogeneity indicators for the outcome of “mortality” in the observational studies considering IFX vs. placebo therapy
Figure 3 C
Figure 3 C
Publication bias indicators for the outcome of “mortality” in the observational studies considering IFX compared to placebo therapy
Figure 3 B-a
Figure 3 B-a
Individual and pooled relative risk for the outcome of “mortality” in the clinical trials considering IFX vs. placebo therapy
Figure 3 B-b
Figure 3 B-b
B-b. Heterogeneity indicators for the outcome of “mortality” in the clinical trials considering IFX vs. placebo therapy
Figure 4 A
Figure 4 A
Individual and pooled relative risk for the outcome of “hospitalization” in the clinical trials considering IFX vs. placebo therapy
Figure 4 B
Figure 4 B
Heterogeneity indicators for the outcome of “hospitalization” in the clinical trials considering IFX vs. placebo therapy
Figure 5 A-a
Figure 5 A-a
Individual and pooled odds ratio for the outcome of “infectious complication” in the observational studies considering IFX vs. placebo therapy
Figure 5 A-b
Figure 5 A-b
Heterogeneity indicators for the outcome of “infectious complication” in the observational studies considering IFX vs. placebo therapy
Figure 5 C
Figure 5 C
Publication bias indicators for the outcome of “infectious complication” in the observational studies considering IFX compared to placebo therapy
Figure 5 B-a
Figure 5 B-a
Individual and pooled odds ratio for the outcome of “infectious complication” in the clinical trials considering IFX vs. placebo therapy
Figure 5 B-b
Figure 5 B-b
Heterogeneity indicators for the outcome of “infectious complication” in the clinical trials considering IFX vs. placebo therapy
Figure 6 A
Figure 6 A
Individual and pooled odds ratio for the outcome of “early post-operative complication” in the observational studies considering IFX vs. placebo therapy
Figure 6 B
Figure 6 B
Heterogeneity indicators for the outcome of “early post-operative complication” in the observational studies considering IFX vs. placebo therapy
Figure 7 A
Figure 7 A
Individual and pooled odds ratio for the outcome of “late post-operative complication” in the observational studies considering IFX vs. placebo therapy
Figure 7 B
Figure 7 B
Heterogeneity indicators for the outcome of “late post-operative complication” in the observational studies considering IFX vs. placebo therapy
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