Anti-TNF and Postoperative Complications in Abdominal Crohn's Disease Surgery
Autor: | Fábio Vieira Teixeira, Silvio Danese, Rogerio Saad-Hossne, Paulo Gustavo Kotze, Takayuki Yamamoto |
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Přispěvatelé: | Yamamoto, T, Teixeira, Fv, Saad-Hossne, R, Kotze, Pg, Danese, S |
Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Clinical Biochemistry Disease Inflammatory bowel disease Sepsis 03 medical and health sciences Postoperative Complications 0302 clinical medicine Crohn Disease Drug Discovery medicine Humans Prospective cohort study Digestive System Surgical Procedures Pharmacology Biological Products Crohn's disease Tumor Necrosis Factor-alpha business.industry Incidence Retrospective cohort study medicine.disease Surgery Clinical trial 030220 oncology & carcinogenesis Molecular Medicine Female 030211 gastroenterology & hepatology business Abdominal surgery |
Zdroj: | Current Drug Targets. 20:1339-1348 |
ISSN: | 1389-4501 |
Popis: | Background: : Biological therapy with anti-Tumour Necrosis Factor (TNF)-α agents revolutionised the treatment of inflammatory bowel disease over the last decades. However, there may be an increased risk of postoperative complications in Crohn’s disease (CD) patients treated with anti-TNF-α agents prior to abdominal surgery. Objective:: To evaluate the effects of preoperative anti-TNF-α therapy on the incidence of complications after surgery. Methods: : A critical assessment of the results of clinical trial outcomes and meta-analyses on the available data was conducted. Results: : Based on the outcomes of previous reports including meta-analyses, preoperative use of anti- TNF-α agents modestly increased the risk of overall complications and particularly infectious complications after abdominal surgery for CD. Nevertheless, previous studies have several limitations. The majority of them were retrospective research with heterogeneous outcome measures and single centre trials with relatively small sample size. In retrospective studies, the standard protocol for assessing various types of postoperative complications was not used. The most serious limitation of the previous studies was that multiple confounding factors such as malnutrition, use of corticosteroids, and preoperative sepsis were not taken into consideration. Conclusion:: Among patients treated with preoperative anti-TNF-α therapy, the risk of overall complications and infectious complications may slightly increase after abdominal surgery for CD. Nevertheless, the previous reports reviewed in this study suffered from limitations. To rigorously evaluate the risk of anti-TNF-α therapy prior to surgery, large prospective studies with standardised criteria for assessing surgical complications and with proper adjustment for confounding variables are warranted. |
Databáze: | OpenAIRE |
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