A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease

INTRODUCTION: Use of biological therapies may reduce or delay the surgical procedures in patients with inflammatory bowel disease (IBD). The aim of this meta-analysis and systematic review was to determine the impact of pre-operative infliximab (IFX) use on the rate of surgical interventions in patients with IBD and also the effect of preoperative IFX therapy on post-surgical complications. MATERIAL AND METHODS: Literature was searched for studies that investigated the efficacy of IFX on the rate of colectomy and post-operative complications/side effects in patients with IBD between 1966 and February 2011. RESULTS: Twelve articles were included in the meta-analysis. In comparison to control groups, patients who received IFX had a relative risk (RR) of 1.17 (p = 0.65) for the rate of colectomy, odds ratio of 3.34 (p = 0.09) in seven observational studies and RR of 0.74 (p = 0.79) in clinical trials for mortality. Summary RR of hospitalization was 0.61 (p = 0.005). Infections and anastomotic leak, pouch-related complications, sepsis and thrombotic events were more common in the patients under IFX therapy but post-operational hospitalization was lower. The patients with IBD who were under IFX therapy were most of the times refractive to other therapies and their disease was more severe. CONCLUSIONS: Although IFX does not decrease the rate of colectomy in patients with IBD, it would not increase most of the post-operational side effects in the patients.