Safety Analysis of Preoperative Anti-TNF-alpha Therapy in Pediatric IBD After Intestinal Resection: A Systematic Review and Meta-analysis

Background: Biological agents have transformed the management of inflammatory bowel disease (IBD). However, intestinal resection is still unavoidable in complicated IBD. It is still under debate whether antitumor necrosis factor (TNF)-alpha is related to higher postoperative complications in children with IBD. Therefore, we aimed to analyze data on preoperative anti-TNF-alpha and postoperative complications in pediatric IBD.Methods: We conducted a systematic literature search in 4 databases for studies that compared the incidence of postoperative complications between children with IBD who received anti-TNF-alpha treatment within 12 weeks prior to intestinal resection and who did not receive anti-TNF-alpha before the operation. To analyze this question, pooled odds ratios (ORs) were calculated with 95% confidence intervals (CIs). Odds ratios higher than 1 mean higher complication rate among children treated with preoperative anti-TNF-alpha, whereas an OR lower than 1 means lower complication rate. The I-2 value was calculated to measure the strength of the between-study heterogeneity, where a smaller percentage means the lower heterogeneity.Results: We found 8 eligible articles with 526 pediatric patients with IBD. The primary outcome was the overall complication. The pooled OR of overall complications was 1.38 (95% CI, 0.10-18.76; P = .65; I-2 = 34%) in contrast, the OR of infectious and noninfectious complications were 0.59 (95% CI, 0.21-1.69; P = .16; I-2 = 0%) and 0.48 (95% CI, 0.18-1.25; p = .09; I-2 = 0%), although both showed a nonsignificant result.Conclusion: There is no significant association between preoperative anti-TNF-alpha therapy and postoperative complications in children with IBD after intestinal resection. However, the evidence is low due to the low number of studies investigating this question.

Automated summary

This study aimed to investigate the association between preoperative anti-TNF-alpha treatment and postoperative complications in pediatric patients with inflammatory bowel disease (IBD). The results showed no significant association between preoperative anti-TNF-alpha therapy and postoperative complications in children with IBD after intestinal resection.