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

BMC Gastroenterology

Research Article

Timothy A. Thornton¹  David Grembowski²  Beth Devine³  Chelle L. Wheat⁴  Kindra Clark-Snustad⁵  Cynthia W. Ko⁵ 

[1] Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA;Department of Health Services, School of Public Health, University of Washington, Box 357660, 1959 NE Pacific Street, Magnuson Health Sciences Center, Room H-680, Seattle, WA, USA;Department of Health Services, School of Public Health, University of Washington, Box 357660, 1959 NE Pacific Street, Magnuson Health Sciences Center, Room H-680, Seattle, WA, USA;Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA;Department of Health Services, School of Public Health, University of Washington, Box 357660, 1959 NE Pacific Street, Magnuson Health Sciences Center, Room H-680, Seattle, WA, USA;Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA;Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA;

关键词: Inflammatory bowel disease;    IBD pharmacotherapy;    Infection;    Network meta-analysis;   

DOI  :  10.1186/s12876-017-0602-0

 received in 2016-10-08, accepted in 2017-03-17,  发布年份 2017

来源: Springer

【 摘 要 】

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).

【 授权许可】

CC BY   
© The Author(s). 2017