The impact of pre-operative biologic therapy on post-operative surgical outcomes in ulcerative colitis: a systematic review and meta-analysis

Zanelli, Jasmine; Chandrapalan, Subashini; Patel, Abhilasha; Arasaradnam, Ramesh P.

doi:10.1177/1756284820937089

Cited by 13 publications

(19 citation statements)

References 49 publications

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“…The risk of postoperative infection or complication may be increased with the use of immunomodulatory biologics [ 40 ]. While studies evaluating this risk have been conducted, most have been in other disease states (e.g., rheumatoid arthritis and ulcerative colitis) or with biologics with different mechanisms of action, such as tumor necrosis factor- α inhibitors (e.g., infliximab and etanercept) [ 40 , 41 ]. There is currently no evidence to support the concern that biologics used in severe asthma and allergic conditions increase the risk of postsurgical complications; as such, on the basis of clinical expert opinion, the dose of the biologics for severe asthma and allergic conditions does not need to be withheld in preparation for surgery or postsurgery and will more likely reduce postoperative respiratory complications.…”

Section: Results and Discussion Section 1: When To Withhold Biologic ...mentioning

confidence: 99%

Guidance for Administering Biologics for Severe Asthma and Allergic Conditions

Dorscheid

Lee²,

Ramesh

et al. 2022

Canadian Respiratory Journal

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Asthma is a common respiratory disorder in Canada for which biologics may be prescribed for poorly controlled illness. Treatment with biologics, however, is sometimes inappropriately discontinued due to misconceptions regarding their potential immunologic effects, and concerns surrounding their continued use in severe asthma during the COVID-19 pandemic continue to propagate. Biologics can still be administered in a majority of health and treatment conditions. With regard to cardiac-related issues such as hypertension or cardiovascular disease (CVD), there is no solid evidence that suggests biologics should be withheld, as the benefits of treatment outweigh the risks. Asthmatic patients on biologic treatment should also continue treatment if they have, or are currently being treated for, a respiratory infection, including COVID-19. Evidence also indicates the importance of maintaining asthma control to reduce the risk of severe COVID-19 infection. Biologic treatment can be administered in severe asthmatic patients with bronchiectasis, though further evidence is needed to better understand the benefits. Biologic treatment should be continued postsurgery to reduce postoperative respiratory complications, as well as throughout the course of pregnancy. Regarding concerns over vaccine administration, nearly all vaccines can be given without interruption of biologic treatment in patients with severe asthma or allergic conditions. Appropriate screening for respiratory illnesses, such as COVID-19, continues to be warranted in clinical practices to reduce the risk of transmission. As recommendations from public health and regulatory agencies have been lacking, this guidance document addresses the administration of biologics in different health circumstances and respiratory illness screening during the COVID-19 pandemic.

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Section: Results and Discussion Section 1: When To Withhold Biologic ...mentioning

confidence: 99%

Guidance for Administering Biologics for Severe Asthma and Allergic Conditions

Dorscheid

Lee²,

Ramesh

et al. 2022

Canadian Respiratory Journal

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Section: Preoperative Periodmentioning

confidence: 99%

“…37 Furthermore, a recent meta-analysis on postoperative infection with anti-TNF inhibitors found that the risk of postoperative infection was increased in patients with CD on anti-TNF agents but not for patients with UC on anti-TNF agents. 38 The data on vedolizumab on postoperative morbidity were conflicting. A single-center, retrospective review compared vedolizumab-exposed patients with CD with patients on anti-TNF or biologic-naive patients and found vedolizumab to be an independent predictor of postoperative surgical site infection.…”

Section: Preoperative Use Of Biologicsmentioning

confidence: 99%

Perioperative Management of Ulcerative Colitis: A Systematic Review

Lee

Faye

Vermeire

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Patients with ulcerative colitis may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. Managing ulcerative colitis is complicated because there are many factors at play, including patient optimization and treatment, as the guidance varies on the ideal perioperative use of corticosteroids, immunomodulators, biologics, and small molecule agents. OBJECTIVE: A systematic literature review was performed to describe the current status of perioperative management of ulcerative colitis. DATA SOURCES: PubMed and Cochrane databases were used. STUDY SELECTION: Studies published between January 2000 and January 2022, in any language, were included. Articles regarding pediatric or endoscopic management were excluded. INTERVENTIONS: Perioperative management of ulcerative colitis was included. MAIN OUTCOME MEASURES: Successful management, including reducing surgical complication rates, was measured. RESULTS: A total of 121 studies were included in this review, including 23 meta-analyses or systematic reviews, 25 reviews, and 51 cohort studies. LIMITATIONS: Qualitative review including all study types. The varied nature of study types precludes quantitative comparison. CONCLUSION: Indications for colectomy in ulcerative colitis include severe disease unresponsive to medical treatment and colitis-associated neoplasia. Urgent colectomy has a higher mortality rate than elective colectomy. Corticosteroids are associated with postsurgical infectious complications and should be stopped or weaned before surgery. Biologics are not associated with adverse postoperative effects and do not necessarily need to be stopped preoperatively. Additionally, the clinician must assess individuals’ comorbidities, nutrition status, and risk of venous thromboembolism. Nutritional imbalance should be corrected, ideally at the preoperative period. Postoperatively, corticosteroids can be tapered on the basis of the length of preoperative corticosteroid use.

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Cira

Weber

Wilhelm

et al. 2022

JCM

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The rate of abdominal surgical interventions and associated postoperative complications in inflammatory bowel disease (IBD) patients is still substantially high. There is an ongoing debate as to whether or not patients who undergo treatment with anti-tumor necrosis factor-alpha (TNF-α) agents may have an increased risk for general and surgical postoperative complications. Therefore, a systematic review and meta-analysis was conducted in order to assess the effect of anti-TNF-α treatment within 12 weeks (washout period) prior to abdominal surgery on 30-day postoperative complications in patients with IBD. The results of previously published meta-analyses examining the effect of preoperative anti-TNF-α treatment on postoperative complications reported conflicting findings which is why we specifically focus on the effect of anti-TNF-α treatment within 12 weeks prior to surgery. PubMed, Cochrane, Scopus, Web of Science, World Health Organization Trial Registry, ClinicalTrials.gov and reference lists were searched (June 1995–February 2022) to identify studies, investigating effects of anti-TNF-α treatment prior to abdominal surgery on postoperative complications in IBD patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and subgroup analyses were performed. In this case, 55 cohort studies (22,714 patients) were included. Overall, postoperative complications (OR, 1.23; 95% CI, 1.04–1.45; p = 0.02), readmission (OR, 1.39; 95% CI, 1.11–1.73; p = 0.004), and intra-abdominal septic complications (OR, 1.89; 95% CI, 1.44–2.49; p < 0.00001) were significantly higher for anti-TNF-α-treated patients. Significantly higher intra-abdominal abscesses and readmission were found for anti-TNF-α-treated CD patients (p = 0.05; p = 0.002). Concomitant treatment with immunosuppressives in <50% of anti-TNF-α-treated patients was associated with significantly lower mortality rates (OR, 0.32; 95% CI, 0.12–0.83; p = 0.02). Anti-TNF-α treatment within 12 weeks prior to surgery is associated with higher short-term postoperative complication rates (general and surgical) for patients with IBD, especially CD.

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The impact of pre-operative biologic therapy on post-operative surgical outcomes in ulcerative colitis: a systematic review and meta-analysis

Cited by 13 publications

References 49 publications

Guidance for Administering Biologics for Severe Asthma and Allergic Conditions

Guidance for Administering Biologics for Severe Asthma and Allergic Conditions

Perioperative Management of Ulcerative Colitis: A Systematic Review

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

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