Systematic review and meta-analysis: Preoperative vedolizumab treatment and postoperative complications in patients with inflammatory bowel disease

Cindy C.Y. Law, Alisha Narula, Amy Lightner, Nicholas P. McKenna, Jean Frederic Colombel, Neeraj Narula

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background and Aims: The impact of vedolizumab, a gut-selective monoclonal antibody, on postoperative outcomes is unclear. This study aimed to assess the impact of preoperative vedolizumab treatment on the rate of postoperative complications in patients with inflammatory bowel disease [IBD] undergoing abdominal surgery. Methods: A systematic search of multiple electronic databases from inception until May 2017 identified studies reporting rates of postoperative complications in vedolizumab-treated IBD patients compared to no biologic exposure or anti-tumor necrosis factor (anti-TNF) treated IBD patients. Outcomes of interest included postoperative infectious complications and overall postoperative complications. Pooled risk ratios and 95% confidence intervals were estimated using the random-effects model. Results: Five studies comprising 307 vedolizumab-treated IBD patients, 490 anti-TNF-treated IBD patients and 535 IBD patients not exposed to preoperative biologic therapy were included. The risk of postoperative infectious complications (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.37- 2.65) and overall postoperative complications [RR 1.00, 95% CI 0.46-2.15] were not significantly different between vedolizumab-treated patients and those who received no preoperative biologic therapy. In addition, the risk of postoperative infectious complications [RR 0.99, 95% CI 0.34-2.90] and overall postoperative complications [RR 0.92, 95% CI 0.44-1.92] were not significantly different between vedolizumab-treated vs anti-TNF-treated patients. Conclusions: Preoperative vedolizumab treatment in IBD patients does not appear to be associated with an increased risk of postoperative infectious or overall postoperative complications compared to either preoperative anti-TNF therapy or no biologic therapy. Future prospective studies which include perioperative drug level monitoring are needed to confirm these findings.

Original languageEnglish (US)
Pages (from-to)538-545
Number of pages8
JournalJournal of Crohn's and Colitis
Volume12
Issue number5
DOIs
StatePublished - Apr 27 2018

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Inflammatory Bowel Diseases
Meta-Analysis
Odds Ratio
Biological Therapy
Confidence Intervals
Tumor Necrosis Factor-alpha
Therapeutics
vedolizumab
Drug Monitoring
Monoclonal Antibodies
Databases
Prospective Studies

Keywords

  • Complications
  • Postoperative
  • Vedolizumab

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Systematic review and meta-analysis : Preoperative vedolizumab treatment and postoperative complications in patients with inflammatory bowel disease. / Law, Cindy C.Y.; Narula, Alisha; Lightner, Amy; McKenna, Nicholas P.; Colombel, Jean Frederic; Narula, Neeraj.

In: Journal of Crohn's and Colitis, Vol. 12, No. 5, 27.04.2018, p. 538-545.

Research output: Contribution to journalArticle

Law, Cindy C.Y. ; Narula, Alisha ; Lightner, Amy ; McKenna, Nicholas P. ; Colombel, Jean Frederic ; Narula, Neeraj. / Systematic review and meta-analysis : Preoperative vedolizumab treatment and postoperative complications in patients with inflammatory bowel disease. In: Journal of Crohn's and Colitis. 2018 ; Vol. 12, No. 5. pp. 538-545.
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abstract = "Background and Aims: The impact of vedolizumab, a gut-selective monoclonal antibody, on postoperative outcomes is unclear. This study aimed to assess the impact of preoperative vedolizumab treatment on the rate of postoperative complications in patients with inflammatory bowel disease [IBD] undergoing abdominal surgery. Methods: A systematic search of multiple electronic databases from inception until May 2017 identified studies reporting rates of postoperative complications in vedolizumab-treated IBD patients compared to no biologic exposure or anti-tumor necrosis factor (anti-TNF) treated IBD patients. Outcomes of interest included postoperative infectious complications and overall postoperative complications. Pooled risk ratios and 95{\%} confidence intervals were estimated using the random-effects model. Results: Five studies comprising 307 vedolizumab-treated IBD patients, 490 anti-TNF-treated IBD patients and 535 IBD patients not exposed to preoperative biologic therapy were included. The risk of postoperative infectious complications (risk ratio [RR] 0.99, 95{\%} confidence interval [CI] 0.37- 2.65) and overall postoperative complications [RR 1.00, 95{\%} CI 0.46-2.15] were not significantly different between vedolizumab-treated patients and those who received no preoperative biologic therapy. In addition, the risk of postoperative infectious complications [RR 0.99, 95{\%} CI 0.34-2.90] and overall postoperative complications [RR 0.92, 95{\%} CI 0.44-1.92] were not significantly different between vedolizumab-treated vs anti-TNF-treated patients. Conclusions: Preoperative vedolizumab treatment in IBD patients does not appear to be associated with an increased risk of postoperative infectious or overall postoperative complications compared to either preoperative anti-TNF therapy or no biologic therapy. Future prospective studies which include perioperative drug level monitoring are needed to confirm these findings.",
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AU - Colombel, Jean Frederic

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