Pre-operative Use of Infliximab and the Risk of Post-operative Infectious Complications in Patients with Inflammatory Bowel Disease: Meta-analysis_West China Medical Journal

Authors：

 LIUYan ,  YUXiao-feng , ZOUJian

Department of Gastroenterology, Huadong Hospital, Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

YUXiao-feng, Email: yuxiaofeng252@163.com

Keywords：

Infliximab; Inflammatory bowel disease; Post-operative infectious complications; Meta-analysis; Observational study

DOI：

10.7507/1002-0179.20150082

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Objective To assess whether pre-operative use of infliximab (IFX) will increase the risk of post-operative infectious complications in patients with inflammatory bowel disease (IBD). Methods Pubmed, Web of Science, CBM, CNKI and Wanfang database were searched for all the trials that investigated the effects of infliximab on postoperative infectious complication rates in patients with IBD between January 1990 and April 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally, 14 cohort studies were finally included in the review. There was no significant difference on infectious complications [RR=0.99, 95%CI (0.47, 2.07), P=0.97] between IFX groups and control groups with ulcerative colitis. The same results were found in patients with Crohn's disease on infectious complications [RR=1.32, 95%CI (0.87, 1.98), P=0.19]. Conclusion Pre-operative infliximab use is safe and does not increase the risk of post-operative infectious complications in patients with IBD.

Citation： LIUYan, YUXiao-feng, ZOUJian. Pre-operative Use of Infliximab and the Risk of Post-operative Infectious Complications in Patients with Inflammatory Bowel Disease: Meta-analysis. West China Medical Journal, 2015, 30(2): 270-274. doi: 10.7507/1002-0179.20150082 Copy

1.	樊星, 翁谢川, 丁日高. 炎症性肠病病因研究进展[J]. 国际消化病杂志, 2013, 33(1):6-8, 16.
2.	伍秋蓉, 周隽, 何继东, 等. 微生态制剂治疗溃疡性结肠炎的系统评价[J]. 中国循证医学杂志, 2008, 8(5):315-321.
3.	Hancock L, Mortensen NJ. How often do IBD patients require resection of their intestine?[J]. Inflamm Bowel Dis, 2008, 14(Suppl 2):S68-S69.
4.	Doherty GA, Cheifetz AS. Management of acute severe ulcerative colitis[J]. Expert Rev Gastroenterol Hepatol, 2009, 3(4):395-405.
5.	Schnitzler F, Fidder H, Ferrante M, et al. Long-term outcome of treatment with infliximab in 614 patients with Crohn's disease:results from a single-centre cohort[J]. Gut, 2009, 58(4):492-500.
6.	Van Assche G, Vermeire S, Rutgeerts P. Management of acute severe ulcerative colitis[J]. Gut, 2011, 60(1):130-133.
7.	Kohn A, Daperno M, Armuzzi A, et al. Infliximab in severe ulcerative colitis:short-term results of different infusion regimens and long-term follow-up[J]. Aliment Pharmacol Ther, 2007, 26(5):747-756.
8.	Järnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study[J]. Gastroenterology, 2005, 128(7):1805-1811.
9.	Eshuis EJ, Al Saady RL, Stokkers PC, et al. Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis[J]. J Crohns Colitis, 2013, 7(2):142-149.
10.	Yang Z, Wu Q, Wu K, et al. Meta-analysis:pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis[J]. Aliment Pharmacol Ther, 2010, 31(4):486-492.
11.	Ehteshami-Afshar S, Nikfar S, Rezaie A, et al. A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease[J]. Arch Med Sci, 2011, 7(6):1000-1012.
12.	Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis[J]. J Am Coll Surg, 2007, 204(5):956-962.
13.	Schluender SJ, Ippoliti A, Dubinsky M, et al. Does infliximab influence surgical morbidity of ileal pouch-anal anastomosis in patients with ulcerative colitis?[J]. Dis Colon Rectum, 2007, 50(11):1747-1753.
14.	Mor IJ, Vogel JD, Da Luz Moreira A, et al. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy[J]. Dis Colon Rectum, 2008, 51(8):1202-1207.
15.	Ferrante M, D'Hoore A, Vermeire S, et al. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis[J]. Inflamm Bowel Dis, 2009, 15(7):1062-1070.
16.	Kunitake H, Hodin R, Shellito PC, et al. Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications[J]. J Gastrointest Surg, 2008, 12(10):1736-1737.
17.	Nørgård BM, Nielsen J, Qvist N, et al. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis:a nationwide cohort study[J]. Aliment Pharmacol Ther, 2012, 35(11):1301-1309.
18.	Bregnbak D, Mortensen C, Bendtsen F. Infliximab and complications after colectomy in patients with ulcerative colitis[J]. J Crohns Colitis, 2012, 6(3):281-286.
19.	Gainsbury ML, Chu DI, Howard LA, et al. Preoperative infliximab is not associated with an increased risk of short-term postoperative complications after restorative proctocolectomy and ileal pouch anal anastomosis[J]. J Gastrointest Surg, 2011, 15(3):397-403.
20.	Marchal L, D'Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn's disease:a controlled cohort study[J]. Aliment Pharmacol Ther, 2004, 19(7):749-754.
21.	Colombel JF, Loftus EJ, Tremaine WJ, et al. Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy[J]. Am J Gastroenterol, 2004, 99(5):878-883.
22.	Appau KA, Fazio VW, Shen B, et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients[J]. J Gastrointest Surg, 2008, 12(10):1738-1744.
23.	Kasparek MS, Bruckmeier A, Beigel F, et al. Infliximab does not affect postoperative complication rates in Crohn's patients undergoing abdominal surgery[J]. Inflamm Bowel Dis, 2012, 18(7):1207-1213.
24.	Nasir BS, Dozois EJ, Cima RR, et al. Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn's disease[J]. J Gastrointest Surg, 2010, 14(12):1865-1866.
25.	Rizzo G, Armuzzi A, Pugliese D,et al. Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience[J]. Int J Colorectal Dis, 2011, 26(11):1435-1444.
26.	Simi M, Leardi S, Minervini S, et al. Early complications after surgery for Crohn's disease[J]. Neth J Surg, 1990, 42(4):105-109.
27.	Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn's disease[J]. Dis Colon Rectum, 2000, 43(8):1141-1145.
28.	Fasth S, Hellberg R, Hultén L, et al. Early complications after surgical treatment for Crohn's disease with particular reference to factors affecting their development[J]. Acta Chir Scand, 1980, 146(7):519-526.
29.	Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infections and mortality in association with therapies for Crohn's disease:TREAT registry[J]. Clin Gastroenterol Hepatol, 2006, 4(5):621-630.
30.	Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids[J]. Rev Infect Dis, 1989, 11(6):954-963.
31.	Subramanian V, Saxena S, Kang JY, et al. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery[J]. Am J Gastroenterol, 2008, 103(9):2373-2381.

1. 樊星, 翁谢川, 丁日高. 炎症性肠病病因研究进展[J]. 国际消化病杂志, 2013, 33(1):6-8, 16.
2. 伍秋蓉, 周隽, 何继东, 等. 微生态制剂治疗溃疡性结肠炎的系统评价[J]. 中国循证医学杂志, 2008, 8(5):315-321.
3. Hancock L, Mortensen NJ. How often do IBD patients require resection of their intestine?[J]. Inflamm Bowel Dis, 2008, 14(Suppl 2):S68-S69.
4. Doherty GA, Cheifetz AS. Management of acute severe ulcerative colitis[J]. Expert Rev Gastroenterol Hepatol, 2009, 3(4):395-405.
5. Schnitzler F, Fidder H, Ferrante M, et al. Long-term outcome of treatment with infliximab in 614 patients with Crohn's disease:results from a single-centre cohort[J]. Gut, 2009, 58(4):492-500.
6. Van Assche G, Vermeire S, Rutgeerts P. Management of acute severe ulcerative colitis[J]. Gut, 2011, 60(1):130-133.
7. Kohn A, Daperno M, Armuzzi A, et al. Infliximab in severe ulcerative colitis:short-term results of different infusion regimens and long-term follow-up[J]. Aliment Pharmacol Ther, 2007, 26(5):747-756.
8. Järnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study[J]. Gastroenterology, 2005, 128(7):1805-1811.
9. Eshuis EJ, Al Saady RL, Stokkers PC, et al. Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis[J]. J Crohns Colitis, 2013, 7(2):142-149.
10. Yang Z, Wu Q, Wu K, et al. Meta-analysis:pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis[J]. Aliment Pharmacol Ther, 2010, 31(4):486-492.
11. Ehteshami-Afshar S, Nikfar S, Rezaie A, et al. A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease[J]. Arch Med Sci, 2011, 7(6):1000-1012.
12. Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis[J]. J Am Coll Surg, 2007, 204(5):956-962.
13. Schluender SJ, Ippoliti A, Dubinsky M, et al. Does infliximab influence surgical morbidity of ileal pouch-anal anastomosis in patients with ulcerative colitis?[J]. Dis Colon Rectum, 2007, 50(11):1747-1753.
14. Mor IJ, Vogel JD, Da Luz Moreira A, et al. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy[J]. Dis Colon Rectum, 2008, 51(8):1202-1207.
15. Ferrante M, D'Hoore A, Vermeire S, et al. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis[J]. Inflamm Bowel Dis, 2009, 15(7):1062-1070.
16. Kunitake H, Hodin R, Shellito PC, et al. Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications[J]. J Gastrointest Surg, 2008, 12(10):1736-1737.
17. Nørgård BM, Nielsen J, Qvist N, et al. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis:a nationwide cohort study[J]. Aliment Pharmacol Ther, 2012, 35(11):1301-1309.
18. Bregnbak D, Mortensen C, Bendtsen F. Infliximab and complications after colectomy in patients with ulcerative colitis[J]. J Crohns Colitis, 2012, 6(3):281-286.
19. Gainsbury ML, Chu DI, Howard LA, et al. Preoperative infliximab is not associated with an increased risk of short-term postoperative complications after restorative proctocolectomy and ileal pouch anal anastomosis[J]. J Gastrointest Surg, 2011, 15(3):397-403.
20. Marchal L, D'Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn's disease:a controlled cohort study[J]. Aliment Pharmacol Ther, 2004, 19(7):749-754.
21. Colombel JF, Loftus EJ, Tremaine WJ, et al. Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy[J]. Am J Gastroenterol, 2004, 99(5):878-883.
22. Appau KA, Fazio VW, Shen B, et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients[J]. J Gastrointest Surg, 2008, 12(10):1738-1744.
23. Kasparek MS, Bruckmeier A, Beigel F, et al. Infliximab does not affect postoperative complication rates in Crohn's patients undergoing abdominal surgery[J]. Inflamm Bowel Dis, 2012, 18(7):1207-1213.
24. Nasir BS, Dozois EJ, Cima RR, et al. Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn's disease[J]. J Gastrointest Surg, 2010, 14(12):1865-1866.
25. Rizzo G, Armuzzi A, Pugliese D,et al. Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience[J]. Int J Colorectal Dis, 2011, 26(11):1435-1444.
26. Simi M, Leardi S, Minervini S, et al. Early complications after surgery for Crohn's disease[J]. Neth J Surg, 1990, 42(4):105-109.
27. Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn's disease[J]. Dis Colon Rectum, 2000, 43(8):1141-1145.
28. Fasth S, Hellberg R, Hultén L, et al. Early complications after surgical treatment for Crohn's disease with particular reference to factors affecting their development[J]. Acta Chir Scand, 1980, 146(7):519-526.
29. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infections and mortality in association with therapies for Crohn's disease:TREAT registry[J]. Clin Gastroenterol Hepatol, 2006, 4(5):621-630.
30. Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids[J]. Rev Infect Dis, 1989, 11(6):954-963.
31. Subramanian V, Saxena S, Kang JY, et al. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery[J]. Am J Gastroenterol, 2008, 103(9):2373-2381.

West China Medical Journal

Pre-operative Use of Infliximab and the Risk of Post-operative Infectious Complications in Patients with Inflammatory Bowel Disease: Meta-analysis

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