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).
Highlights
The magnitude of risk of serious infections due to available medical therapies of inflammatory bowel disease (IBD) remains controversial
One of the identified trials did not fit into the connected network because of its treatment comparators, which were not examined in any of the other included trials; this trial was excluded and thirty-eight trials were included in the final analysis
Our results are in contrast to those reported by Toruner et al who showed an increased risk of opportunistic infections among patients treated with combination therapy in a retrospective case–control study [4]
Summary
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. Corticosteroids, immunomodulators, and biologic medications in particular can have significant adverse effects, possibly including a higher risk of infection. Serious infections in particular are relatively rare, and large cohorts of treated patients are required to determine the incidence for specific medications [2]. Many of these therapies have never been compared directly to each other in the existing literature
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