PRE-OPERATIVE USTEKINUMAB TREATMENT AND POST-OPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS
Nancy Gupta*3, Joseph D. Feuerstein1, Q. Eileen Wafford2, Emanuelle Bellaguarda3, Vitaliy Poylin4
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 2Northwestern University, Chicago, IL; 3Northwestern Gastroenterology, Chicago, IL; 4Northwestern Gastrointestinal Surgery, Chicago, IL
Background
Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23 to treat Crohn’s disease. This study aims to assess the impact of preoperative Ustekinumab on post-operative complications in patients with Crohn’s disease undergoing abdominal surgery.
Methods
We searched PubMed, Medline, Embase, Ovid, Web of Science and Cochrane for studies reporting rates of post-operative complications in Ustekinumab treated patients with Crohn’s disease. Outcomes studied were post-operative infectious complications and need for stoma. Mantel-Haenszel risk ratio (RR) random effects model was used to summarize data between the two groups. Heterogeneity was assessed using I2 statistics
Results
Six studies comprising 143 Ustekinumab treated patients, 481 anti-TNF alpha inhibitors and 200 Vedolizumab treated patients were included in this meta-analysis. The risk of postoperative infectious complications for Ustekinumab was not statistically significant when compared to anti-TNF alpha inhibitor group (RR 0.95, 95% CI 0.26-3.45; p = 0.94; I2 = 76%) or Vedolizumab group (RR 0.99, 95% CI 0.31-3.13; p=0.99; I2 = 51%). No difference was observed for the need for stoma in patients treated with Ustekinumab or anti-TNF alpha inhibitors (RR 2.99, 95% CI 0.96-9.32; p=0.06; I2 = 84%).
Conclusions
Preoperative Ustekinumab use was not associated with reduced post-operative complication rates as compared to anti-TNF or Vedolizumab in patients with Crohn’s disease undergoing abdominal surgery; but there was substantial heterogeneity between trials.
Forest plot demostrating risk of post operative infectious complications and need for stoma in patients Ustekinumab vs anti TNF and Ustekinumab vs Vedolizumab
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