Abstract

Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease. A meta-analysis

Sarlos P1,2, Szemes K1, Hegyi P1,2,3, Garami A2, Szabo I1, Illes A1, Solymar M2, Petervari E2, Vincze A1, Par G1, Bajor J1, Czimmer J1, Huszar O4, Varju P2,5, Farkas N2,5,6. J Crohns Colitis. 2017 Dec 6. doi: 10.1093/ecco-jcc/jjx162. [Epub ahead of print]
 
     
Author information

1 Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.

2 Institute for Translational Medicine, University of Pécs, Pécs, Hungary.

3 Hungarian Academy of Sciences-University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary.

4 First Department of Surgery, Semmelweis University, Budapest, Hungary.

5 Szentágothai Research Centre, University of Pécs, Pécs, Hungary.

6 Institute of Bioanalysis, University of Pécs, Pécs, Hungary.

Abstract

BACKGROUND AND AIM: Inflammatory bowel disease [IBD] is associated with 1.5- to 3-fold increased risk of venous thromboembolic events [VTE]. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumor necrosis factor alpha [TNFα] therapies.

METHODS: A systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses [PRISMA] statement. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for English-language studies published from inception inclusive 15 April 2017. The population-intervention-comparison-outcome [PICO] format and statistically the random-effects and fixed-effect models were used to compare VTE risk during steroid and anti-TNFα treatment. Quality of the included studies was assessed using the Newcastle-Ottawa scale. PROSPERO registration number is 42017070084.

RESULTS: We identified 817 records, of which eight observational studies, involving 58,518 IBD patients, were eligible for quantitative synthesis. In total, 3,260 thromboembolic events occurred. Systemic corticosteroids were associated with a significantly higher rate of VTE complication in IBD patients as compared to IBD patients without steroid medication [OR: 2.202; 95% CI: 1.698-2.856, p < 0.001]. In contrast, treatment with anti-TNFα agents resulted in a 5-fold decreased risk of VTE compared to steroid medication [OR: 0.267; 95% CI: 0.106-0.674, p = 0.005].

CONCLUSION: VTE risk should be carefully assessed and considered when deciding between anti-TNFα and steroids in the management of severe flare-ups. Thromboprophylaxis guidelines should be followed, no matter the therapy choice.

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