Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis

Aliment Pharmacol Ther. 2010 Feb 15;31(4):486-92. doi: 10.1111/j.1365-2036.2009.04204.x. Epub 2009 Nov 19.

Abstract

Background: Infliximab was approved for use in ulcerative colitis in recent years. It has been debated if infliximab increases the risk of post-operative complications in patients with ulcerative colitis.

Aim: To perform a meta-analysis that examines the relationship between preoperative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis.

Methods: We searched the PubMed and MEDLINE databases to identify observational studies on the impact of pre-operative infliximab use on short-term post-operative complications in ulcerative colitis. Infectious complications mainly included wound infection, sepsis and abscess, whereas non-infectious complications included intestinal obstruction, thromboembolism and gastrointestinal haemorrhage. Pooled odds ratios (ORs) were calculated for each relationship.

Results: A total of 5 studies and 706 patients were included in our meta-analysis. Overall, we did not find a strong association between pre-operative treatment of infliximab and short-term infectious [OR 2.24, 95% confidence interval (CI) 0.63-7.95] or non-infectious (OR 0.85, 95% CI 0.50-1.45) post-operative complications in ulcerative colitis patients. On the contrary, we discovered that pre-operative infliximab use increased short-term total post-operative complications (OR 1.80, 95% CI 1.12-2.87).

Conclusions: Pre-operative infliximab use increased the risk of short-term post-operative complications. Subgroup analysis is underpowered to assess the nature of these complications but shows a trend towards increased post-operative infection.

Publication types

  • Meta-Analysis

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Colitis, Ulcerative / drug therapy*
  • Colitis, Ulcerative / surgery*
  • Combined Modality Therapy
  • Control Groups
  • Drug Therapy, Combination
  • Gastrointestinal Agents / adverse effects*
  • Humans
  • Immunologic Factors / administration & dosage
  • Immunologic Factors / adverse effects
  • Infliximab
  • Odds Ratio
  • Postoperative Complications / epidemiology
  • Preoperative Care
  • Proctocolectomy, Restorative / adverse effects*
  • Proctocolectomy, Restorative / statistics & numerical data
  • PubMed
  • Surgical Wound Infection / epidemiology
  • Time Factors
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Gastrointestinal Agents
  • Immunologic Factors
  • Infliximab