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Anti-TNF linked to postoperative complications in Crohn’s
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Patients with Crohn’s disease who have previous exposure to anti-TNF are at higher risk for infectious complications following surgery, according to data from a systematic review and meta-analysis.
Chiehfeng Chen, PhD, MPH, of Taipei Medical University, and colleagues wrote that previous meta-analyses linked anti-TNF to postoperative complications, but the effect is still debated.
“These metaanalyses might be biased as they included retrospective studies and did not perform appropriate adjustments for major factors including disease severity, comorbidities, and concomitant medications,” they wrote. “Two recent prospective cohort studies calibrated these confounders, but their results were conflicting.”
Chen and colleagues searched the literature for studies about patients with CD who needed abdominal surgery and were either treated preoperatively with anti-TNF or were not exposed to anti-TNF. They included 20 studies comprising 7,115 patients in their analysis.
Without adjusting for confounders, researchers found that anti-TNF exposure was associated with increased rates of infectious complications (OR = 1.49; 95% CI, 1.08–2.06). After adjusting for confounders, investigators found that anti-TNF exposure was linked to increased rates of total complications (adjusted OR = 1.52; 95% CI, 1.11–2.09) and infectious complications (aOR = 2.09; 95% CI, 1.19–3.65).
After subgroup analysis, Chen and colleagues found that the association between anti-TNF and total complications was significant in countries with higher incidence (aOR = 1.86; 95% CI, 1.43–2.42) but not in countries with low incidence (aOR = 0.77; 95% CI, 0.48–1.25).
“We recommend either postponing elective surgery or careful postoperative monitoring in patients with CD who have been exposed to anti-TNF agents,” they wrote. “Further large prospective cohort studies are required to clarify our findings.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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