Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis.
Westerouen van Meeteren MJ, Hayee B, et al.Journal of Crohn's & colitis 2017; 11(9): 1146-1151.
Aims
To conduct a systematic review and meta-analysis to investigate the risk of serious infection in liver transplant recipients with and without anti-tumour necrosis factor (TNF) exposure.
Interventions
The databases PubMed, Embase, Cochrane and Web of Science were searched by two authors and a library information specialist until January 2017 for full papers, letters and abstracts. Two authors independently reviewed and selected studies eligible for the final analysis. Prospective and retrospective studies in English were included that reported on the incidence of serious infections in post-transplantation patients under treatment with any anti-TNF therapy for inflammatory bowel disease.
Participants
8 papers were included in the analysis which included data from 53 patients on anti-TNF therapy and 23 control patients not on anti-TNF therapy.
Outcomes
Outcomes measured included the rate ratio of infections and serious infections and the number and type of infections.
Follow-up
Variable - Over 100 patient-years of follow-up during TNF-exposure were analysed
CET Conclusions
There are good quality indicators in this report: The number and type of databases searched, the duplicate data extraction, the quality assessment and the description of papers excluded. The authors identified only 8 studies, with relatively few patients and therefore included a cohort from their own unit to increase the number of patients available to the control arm. The papers available to them were either case series or cohort studies and two were case reports of single cases. The authors did not find a significantly increased risk of anti-TNF alpha treatment for IBD after liver transplant, however the confidence intervals presented are very large due to the small study sizes. There may therefore be an increased clinical risk in reality that has not been identified by this meta-analysis.
Quality notes
Quality assessment not appropriate
Trial registration
None