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

Background The 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 patien...

Full description

Saved in:
Bibliographic Details
Published in:BMC gastroenterology Vol. 17; no. 1; pp. 52 - 15
Main Authors: Wheat, Chelle L., Ko, Cynthia W., Clark-Snustad, Kindra, Grembowski, David, Thornton, Timothy A., Devine, Beth
Format: Journal Article
Language:English
Published: London BioMed Central 14.04.2017
Springer Nature B.V
BMC
Subjects:
Adrenal Cortex Hormones - therapeutic use
Anti-Bacterial Agents - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Antibiotics
Biological Products - therapeutic use
Drug therapy
Gastroenterology
Hepatology
Humans
IBD pharmacotherapy
Immunologic Factors - therapeutic use
Infection
Infections
Infections - epidemiology
Inflammation
Inflammatory bowel disease
Inflammatory Bowel Diseases - drug therapy
Internal Medicine
Intestinal disorders
Medicine
Medicine & Public Health
Meta-analysis
Network meta-analysis
Research Article
Risk Factors
Studies
Tuberculosis
Inflammatory bowel disease
Infection
IBD pharmacotherapy
Network meta-analysis
ISSN:1471-230X, 1471-230X
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background The 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. Methods Studies 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. Results Thirty-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. Conclusions No 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 registration The protocol for this systematic review was registered on PROSPERO ( CRD42014013497 ).
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
content type line 14
ObjectType-Feature-3
ObjectType-Evidence Based Healthcare-1
ObjectType-Article-1
ObjectType-Feature-2
ObjectType-Review-3
content type line 23
ObjectType-Undefined-4
ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-017-0602-0