Systematic Review And Meta-Analysis On The Association Of Tuberculosis In Crohn'S Disease Patients Treated With Tumor Necrosis Factor-Α Inhibitors (Anti-Tnfα)

Keywords

Crohn's Disease; Meta-analysis; Systematic review; Tuberculosis; Tumor necrosis factor-alpha inhibitors

Abstract

AIM To perform a meta-analysis on the risk of developing Mycobacterium tuberculosis (TB) infection in Crohn's disease (CD) patients treated with tumor necrosis factoralpha (TNFα) inhibitors. METHODS A meta-analysis of randomized, double-blind, placebocontrolled trials of TNFα inhibitors for treatment of CD in adults was conducted. Arcsine transformation of TB incidence was performed to estimate risk difference. A novel epidemiologically-based correction (EBC) enabling inclusions of studies reporting no TB infection cases in placebo and treatment groups was developed to estimate relative odds. RESULTS Twenty-three clinical trial studies were identified, including 5669 patients. Six TB infection cases were reported across 5 studies, all from patients receiving TNFα inhibitors. Eighteen studies reported no TB infection cases in placebo and TNFα inhibitor treatment arms. TB infection risk was significantly increased among patients receiving TNFα inhibitors, with a risk difference of 0.028 (95%CI: 0.0011-0.055). The odds ratio was 4.85 (95%CI: 1.02-22.99) with EBC and 5.85 (95%CI: 1.13-30.38) without EBC. CONCLUSION The risk of TB infection is higher among CD patients receiving TNFα inhibitors. Understanding the immunopathogenesis of CD is crucial, since using TNFα inhibitors in these patients could favor mycobacterial infections, particularly Mycobacterium avium subspecies paratuberculosis , which ultimately could worsen their clinical condition.

Publication Date

7-7-2018

Publication Title

World Journal of Gastroenterology

Volume

24

Issue

25

Number of Pages

2764-2775

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.3748/wjg.v24.i25.2764

Socpus ID

85049684809 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/85049684809

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