Inflammatory Bowel Disease (IBD) pharmacotherapy and the risk of serious infection: a systematic review and network meta-analysis

Abstract

BackgroundThe magnitude of risk of serious infections due to available medical therapies of inflammatory bowel disease (IBD) remains controversial. We conducted a systematic review and network meta-analysis of the existing IBD literature to estimate the risk of serious infection in adult IBD patients associated with available medical therapies.MethodsStudies were identified by a literature search of PubMed, Cochrane Library, Medline, Web of Science, Scopus, EMBASE, and ProQuest Dissertations and Theses. Randomized controlled trials comparing IBD medical therapies with no restrictions on language, country of origin, or publication date were included. A network meta-analysis was used to pool direct between treatment comparisons with indirect trial evidence while preserving randomization.ResultsThirty-nine articles fulfilled the inclusion criteria; one study was excluded from the analysis due to disconnectedness. We found no evidence of increased odds of serious infection in comparisons of the different treatment strategies against each other, including combination therapy with a biologic and immunomodulator compared to biologic monotherapy. Similar results were seen in the comparisons between the newer biologics (e.g. vedolizumab) and the anti-tumor necrosis factor agents.ConclusionsNo treatment strategy was found to confer a higher risk of serious infection than another, although wide confidence intervals indicate that a clinically significant difference cannot be excluded. These findings provide a better understanding of the risk of serious infection from IBD pharmacotherapy in the adult population.Prospero registrationThe protocol for this systematic review was registered on PROSPERO (CRD42014013497).Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0602-0) contains supplementary material, which is available to authorized users.

Clerodane Diterpene Ameliorates Inflammatory Bowel Disease and Potentiates Cell Apoptosis of Colorectal Cancer

“…Usually, the conventional therapies for IBD can be grouped into the two following approaches: anti-inflammation, e.g., corticosteroids, mesalazine, and cyclosporine; and anti-microbial, including ornidazole and rifaximin [24]. Ordinarily, these drugs are useful for treating mild to moderate IBD.…”

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“…Among studies of combination therapy, neither randomised controlled trials nor network meta‐analyses have demonstrated an increased risk of serious infections in patients receiving combination therapy versus anti‐TNF monotherapy . These results should be interpreted with caution given the relatively small numbers and short duration of follow‐up of patients in clinical trials.…”

“…37 Among studies of combination therapy, neither randomised controlled trials nor network meta-analyses have demonstrated an increased risk of serious infections in patients receiving combination therapy versus anti-TNF monotherapy. 33,38 These results should be interpreted with caution given the relatively small numbers and short duration of follow-up of patients in clinical trials. Nevertheless, higher rates of opportunistic, but not serious, infections have been reported in retrospective case-control and cohort studies of patients treated with combination therapy.…”

Management of inflammatory bowel diseases in the wake of COVID‐19 pandemic

“…Previous literature, plagued with inconsistencies and conflicting evidence, have estimated the risk of infections with IBD pharmacotherapy between 0.5% and 30%. 2 A study of 2600 IBD patients indicated that active disease and use of thiopurines were independent risk factors for serious viral infections. 3 Meta-analyses for different biologics used in IBD have failed to report a significantly greater risk of infection for most of them, although the data mostly comes from RCTs.…”

“…One study reported disease relapse rate of 27% within first year after TNFαinhibitor discontinuation. 2 Patients who develop disease flares may require higher doses of immunosuppressants to achieve control and may even require hospitalization and/or endoscopic eval-uation. The SARS-CoV-2 virus has shown rapid transmission in health-care facilities where other infected individuals arrive for their care and even asymptomatic carries could transmit the disease.…”