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Remicade safe prior to surgery in patients with Crohn’s
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Patients taking Remicade for the treatment of Crohn’s disease do not have to discontinue therapy before undergoing surgery, according to data from a meta-analysis published in Inflammatory Bowel Disease.
Gang Liu, MD, PhD, of the department of general surgery at Tianjin Medical University General Hospital in China, and colleagues wrote that determining the risk for post-operative complications from Remicade (infliximab, Janssen) is important because such a large portion of patients with CD go on to have surgery.
“One-third of Crohn’s disease patients require surgical treatment when the duration of disease is more than 5 years,” they wrote. “Seventy percent of CD patients are inevitably operated on during their lifetime.”
Liu and colleagues searched the literature and found 18 studies comprising 1,407 patients who received infliximab and underwent ileocolonic resection and 4,589 patients who did not received infliximab prior to surgery. They assessed differences in cumulative overall, major, minor, infectious, noninfectious, surgical and medical complications between the two groups.
In studies that recorded cumulative overall complications, Liu and colleagues found no significant difference in incidence between the two groups. In the infliximab group, 619 of 1,309 patients experienced complications compared with 1,064 of 4,189 patients in the non-infliximab group (OR = 1.17; 95% CI, 0.82–1.66).
Additionally, they found no significant difference in incidence in other outcome measures: major (OR = 1.41; 95 CI, 0.85–2.34) or minor complications (OR = 1.14; 95% CI, 0.81–1.61); infectious (OR = 1.23; 95% CI, 0.87–1.74) or noninfectious complications (OR = 1.06; 95% CI, 0.88–1.28); surgical complications (OR = 1.14; 95% CI, 0.82–1.58), and medical complications (OR = 1.32; 95% CI, 0.98–1.78).
Additionally, researchers found no significant difference in reoperation, readmission or mortality between the two groups.
Liu and colleagues wrote that their findings show that infliximab appears relatively safe for preoperative use for the treatment of CD.
“Patients with CD who need surgery do not need to have [infliximab] withdrawn before the operation,” they wrote. “However, the safety of [infliximab] still needs to be verified by long-term observational studies with larger sample sizes.” – by Alex Young
Disclosures: The study was supported by the Li Jie-shou Gut Barrier Foundation. Healio Gastroenterology and Liver Disease was unable to determine the authors’ relevant financial disclosures prior to publication.”
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