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Opportunistic Infections in Patients with Inflammatory Bowel Disease Treated with Advanced Therapies: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

医学 随机对照试验 入射(几何) 炎症性肠病 内科学 安慰剂 免疫抑制 荟萃分析 疾病 重症监护医学 替代医学 病理 光学 物理
作者
Pablo A. Olivera,Juan S. Lasa,Ignacio Zubiaurre,Vipul Jairath,María T. Abreu,David Rubin,Walter Reinisch,Fernando Magro,Jean‐François Rahier,Silvio Danese,Christian Rabaud,Laurent Peyrin‐Biroulet
出处
期刊:Journal of Crohn's and Colitis [Oxford University Press]
卷期号:17 (2): 199-210 被引量:8
标识
DOI:10.1093/ecco-jcc/jjac133
摘要

Advanced therapies for inflammatory bowel disease [IBD] could potentially lead to a state of immunosuppression with an increased risk of opportunistic infections [OIs]. We aimed to provide an update on the incidence of OIs among adult IBD patients in randomized controlled trials [RCTs] of approved biologics and small-molecule drugs [SMDs]. Also, we aimed to describe OI definitions utilized in RCTs, to ultimately propose a standardized definition.Electronic databases were searched from January 1, 1990, until April 16, 2022. Our primary outcome was incidence rate of overall OIs among IBD patients exposed and unexposed to biologics or SMDs. We also describe specific OIs reported in included trials, as well as definitions of OIs within studies when provided.Ninety studies were included. The incidence rates of reported OIs were 0.42 and 0.21 per 100 person-years in patients exposed to advanced therapies and placebo, respectively. This was highest for anti-tumour necrosis factors [0.83 per 100 person-years] and Janus kinase inhibitors [0.55 per 100 person-years] and lowest for anti-integrins and ozanimod. On meta-analysis, no increased risk of OIs was observed. None of the studies provided a detailed definition of OIs, or a comprehensive list of infections considered as OIs.Different mechanisms of action may have specific OI profiles. In the absence of a uniform definition of OIs, these estimates are less reliable. We propose a definition to be used in future studies to help provide standardized reporting. When using this definition, we saw significant differences in incidence rates of OIs across mechanisms of action.
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