Adverse events of biologic or small molecule therapies in clinical trials for inflammatory bowel disease: A systematic review and meta-analysis

Abstract

BackgroundBiologic or small-molecule therapies are highly effective for the treatment of inflammatory bowel disease (IBD), and approval by the FDA has significantly increased both their clinical use and the development of novel regimens. However, the identification and management of their associated toxicities poses challenges for clinicians and researchers. MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) published from January 1, 2000, to October 15, 2022, and in the databases. A random-effects model with logit transformation was applied to the analysis heterogeneity between studies was evaluated using the I2 statistic with incidence and 95 % confidence interval (CI) for any adverse events (AEs), and serious AEs (SAEs). ResultsIn Crohn's disease (CD), the total AE incidence was 67.0 % (95 % CI, 66.2%–67.8 %; I2 = 97.2 %) for any AEs and 7.3 % (6.9–7.7; 97.2) for serious AEs. In ulcerative colitis (UC), the overall incidence of any and serious AEs was 63.6 % (63.0–64.3; 98.1) and 5.7 % (5.4–6.0; 88.9), respectively. The most common AEs were infections (21.5 [20.3–22.8], 32.6 [31.0–34.2], 25.9 [24.5–27.2], and 13.7 [10.7–16.7]) in CD patients that were treated with TNF antagonists, anti-integrins, anti-IL agents, and JAK inhibitors, respectively, and in UC patients also were infections (22.8 [21.7–24.0], 27.4 [25.9–28.9], and 18.4 [16.7–20.2]), respectively, as well as increases in lactic dehydrogenase levels (23.1 [20.8–25.4]) with JAK inhibitors. ConclusionThis study offers a comprehensive summary of toxic side effects of IBD treatments and a useful reference for both patients and clinicians.