Systematic review and meta-analysis: risks of postoperative complications with preoperative use of anti-tumor necrosis factor-alpha biologics in inflammatory bowel disease patients

Abstract

PURPOSE Cinnamon has been studied in randomized controlled trials (RCTs) for its glycemic-lowering effects, but studies have been small and show conflicting results. A prior meta-analysis did not show significant results, but several RCTs have been published since then. We conducted an updated systematic review and meta-analysis of RCTs evaluating cinnamon's effect on glycemia and lipid levels. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2012. Included RCTs evaluated cinnamon compared with control in patients with type 2 diabetes and reported at least one of the following: glycated hemoglobin (A 1c), fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides. Weighted mean differences (with 95% confidence intervals) for endpoints were calculated using random-effects models. RESULTS In a meta-analysis of 10 RCTs (n = 543 patients), cinnamon doses of 120 mg/d to 6 g/d for 4 to 18 weeks reduced levels of fasting plasma glucose (-24.59 mg/dL; 95% CI,-40.52 to-8.67 mg/dL), total cholesterol (-15.60 mg/ dL; 95% CI,-29.76 to-1.44 mg/dL), LDL-C (-9.42 mg/dL; 95% CI,-17.21 to-1.63 mg/dL), and triglycerides (-29.59 mg/dL; 95% CI,-48.27 to-10.91 mg/ dL). Cinnamon also increased levels of HDL-C (1.66 mg/dL; 95% CI, 1.09 to 2.24 mg/dL). No significant effect on hemoglobin A 1c levels (-0.16%; 95%, CI-0.39% to 0.02%) was seen. High degrees of heterogeneity were present for all analyses except HDL-C (I 2 ranging from 66.5% to 94.72%). CONCLUSIONS The consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels; however, no significant effect on hemoglobin A 1c was found. The high degree of heterogeneity may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear.

The Effect of Anti-Tumor Necrosis Factor-Alpha Therapy within 12 Weeks Prior to Surgery on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…The results of previously published meta-analyses reported conflicting findings. Some studies reported a significant increase in overall postoperative complications [ 7 , 8 , 9 , 16 ] or overall infectious postoperative complications [ 3 , 6 , 7 , 9 , 16 ] for anti-TNF-α treated patients, others did not. [ 3 , 5 , 12 , 15 , 17 ].…”

“…Furthermore, to our knowledge, such extensive subgroup analyses stratified for both the IBD subtype and potential risk factors, were not performed before. [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…However, in comparison with the general population, the 5-year surgery rates with its accompanying potential postoperative complications remain substantial for IBD patients. [ 2 ] Previously conducted meta-analyses, analyzing the effect of preoperative anti-TNF-α treatment on postoperative complications has reported conflicting findings [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…The latter is mostly the result of including different preoperative drug withdrawal periods in the analyses. [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] In order to find consistent values regarding the effect of preoperative anti-TNF-α treatment on postoperative complications and to ensure better comparisons of data, we chose the objectifiable anti-TNF-α drug washout period of 12 weeks [ 18 ] as the preoperative cut-off value in this analysis.…”

Surgical Planning in Penetrating Abdominal Crohn's Disease

“…As a result, recent meta-analyses of published literature suffer from a significant heterogeneity (I2 23–64%) and are contradictory in their conclusions ( 80 ). Three recent reviews conclude that pre-operative anti-TNF therapy is associated with an increased rate of post-operative infectious complications ( 81 – 83 ), while one did not find such an association ( 84 ). National and international guidelines are also contradictory regarding the management of pre-operative anti-TNF therapy ( 55 , 85 ).…”