Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience

Abstract

High-dose corticosteroids increased the risk of short-term postoperative cumulative and infective complications. Anti-TNF drugs within 12 weeks prior to abdominal surgery in patients with IBD did not appear to increase the rate of postoperative complications.

Meta‐analysis: peri‐operative anti‐TNFα treatment and post‐operative complications in patients with inflammatory bowel disease

“…Four studies reported a mixed cohort of IBD patients, one of which was excluded due to a low NOS score . Overall, 18 studies with 4659 participants were eligible for meta‐analysis . Infectious complication rates could be calculated for 16 of these studies, non‐infectious complications for 14, and total complication rates for 15 studies.…”

Guidelines for the management of ulcerative colitis. Recommendations of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology

“…W innych badaniach natomiast wykazano jedynie zwiększenie ryzyka wy stąpienia powikłań infekcyjnych [80,81]. Istnieją jednak dane przeczące także i takiej zależności.…”

Intestinal Surgery for Crohn's Disease: Role of Preoperative Therapy in Postoperative Outcome

“…Differently from infliximab that is administered intravenously once every 2 months, adalimumab is given as a subcutaneous injection, once every other week. In spite of severe adverse events, some related to surgery, described at the beginning of the clinical use of anti-TNFα therapies [28] , several subsequent studies did not observe any major adverse effect on surgical outcome of patients [7][8][9][10][11] . Moreover, in rabbits no relevant effect of a single therapeutic dose of adalimumab on anastomotic strength, histological parameters or collagen formation was observed [29] .…”

“…In fact, in spite of the widespread use of steroids to treat CD [25] , no data are available concerning the risk of postoperative complications associated to topical ones. According to a recent meta-analysis, systemic and oral glucocorticosteroids are beneficial to CD patients [20] but the increased risk of short-term postoperative complications after their use is well known [5][6][7]26] . On the contrary, budesonide has been demonstrated to be safe for long-term use at doses below 6 mg/day, but at the maximal dose of 6 mg/day, endocrine dysfunction and infection rate become significant [27] .…”

“…In fact, several studies, including a very recent multi-centric one and a population-based one, claimed that anti-TNFα treatment during the 12 weeks prior to abdominal surgery did not increase the rate of postoperative complications in patients with CD or UC [7][8][9][10][11] . On the other hand, in patients undergoing restorative proctocolectomy for UC treated with infliximab before surgery, the odds of postoperative pouch-related and infectious complications [12,13] have substantially increased.…”