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

Patricia Sarlos, Kata Szemes, P. Hegyi, Andras Garami, Imre Szabo, Anita Illes, Margit Solymar, Erika Petervari, A. Vincze, G. Pár, Judit Bajor, Jozsef Czimmer, Orsolya Huszar, Peter Varju, Nelli Farkas

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Background and Aims: Inflammatory bowel disease [IBD] is associated with a 1.5-to 3-fold increased risk of venous thromboembolism [VTE] events. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumour 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 of 15 April 2017. The population-intervention-comparisonoutcome [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. The 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, 3260 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 (odds ratio [OR]: 2.202; 95% confidence interval [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.

Original languageEnglish
Pages (from-to)489-498
Number of pages10
JournalJournal of Crohn's and Colitis
Volume12
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

Fingerprint

Biological Therapy
Venous Thromboembolism
Inflammatory Bowel Diseases
Meta-Analysis
Steroids
Tumor Necrosis Factor-alpha
Adrenal Cortex Hormones
Odds Ratio
Library Science
Confidence Intervals
Therapeutics
PubMed
Observational Studies
Language
Guidelines
Population

Keywords

  • Anti-TNFα
  • Corticosteroids
  • Inflammatory bowel diseases
  • Therapy
  • Venous thromboembolism

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease : A meta-analysis. / Sarlos, Patricia; Szemes, Kata; Hegyi, P.; Garami, Andras; Szabo, Imre; Illes, Anita; Solymar, Margit; Petervari, Erika; Vincze, A.; Pár, G.; Bajor, Judit; Czimmer, Jozsef; Huszar, Orsolya; Varju, Peter; Farkas, Nelli.

In: Journal of Crohn's and Colitis, Vol. 12, No. 4, 01.04.2018, p. 489-498.

Research output: Contribution to journalReview article

Sarlos, P, Szemes, K, Hegyi, P, Garami, A, Szabo, I, Illes, A, Solymar, M, Petervari, E, Vincze, A, Pár, G, Bajor, J, Czimmer, J, Huszar, O, Varju, P & Farkas, N 2018, 'Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease: A meta-analysis', Journal of Crohn's and Colitis, vol. 12, no. 4, pp. 489-498. https://doi.org/10.1093/ecco-jcc/jjx162
Sarlos, Patricia ; Szemes, Kata ; Hegyi, P. ; Garami, Andras ; Szabo, Imre ; Illes, Anita ; Solymar, Margit ; Petervari, Erika ; Vincze, A. ; Pár, G. ; Bajor, Judit ; Czimmer, Jozsef ; Huszar, Orsolya ; Varju, Peter ; Farkas, Nelli. / Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease : A meta-analysis. In: Journal of Crohn's and Colitis. 2018 ; Vol. 12, No. 4. pp. 489-498.
@article{bd4672086ac84a108d188ebf4bb4928f,
title = "Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease: A meta-analysis",
abstract = "Background and Aims: Inflammatory bowel disease [IBD] is associated with a 1.5-to 3-fold increased risk of venous thromboembolism [VTE] events. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumour 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 of 15 April 2017. The population-intervention-comparisonoutcome [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. The 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, 3260 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 (odds ratio [OR]: 2.202; 95{\%} confidence interval [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.",
keywords = "Anti-TNFα, Corticosteroids, Inflammatory bowel diseases, Therapy, Venous thromboembolism",
author = "Patricia Sarlos and Kata Szemes and P. Hegyi and Andras Garami and Imre Szabo and Anita Illes and Margit Solymar and Erika Petervari and A. Vincze and G. P{\'a}r and Judit Bajor and Jozsef Czimmer and Orsolya Huszar and Peter Varju and Nelli Farkas",
year = "2018",
month = "4",
day = "1",
doi = "10.1093/ecco-jcc/jjx162",
language = "English",
volume = "12",
pages = "489--498",
journal = "Journal of Crohn's and Colitis",
issn = "1873-9946",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease

T2 - A meta-analysis

AU - Sarlos, Patricia

AU - Szemes, Kata

AU - Hegyi, P.

AU - Garami, Andras

AU - Szabo, Imre

AU - Illes, Anita

AU - Solymar, Margit

AU - Petervari, Erika

AU - Vincze, A.

AU - Pár, G.

AU - Bajor, Judit

AU - Czimmer, Jozsef

AU - Huszar, Orsolya

AU - Varju, Peter

AU - Farkas, Nelli

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background and Aims: Inflammatory bowel disease [IBD] is associated with a 1.5-to 3-fold increased risk of venous thromboembolism [VTE] events. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumour 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 of 15 April 2017. The population-intervention-comparisonoutcome [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. The 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, 3260 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 (odds ratio [OR]: 2.202; 95% confidence interval [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.

AB - Background and Aims: Inflammatory bowel disease [IBD] is associated with a 1.5-to 3-fold increased risk of venous thromboembolism [VTE] events. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumour 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 of 15 April 2017. The population-intervention-comparisonoutcome [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. The 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, 3260 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 (odds ratio [OR]: 2.202; 95% confidence interval [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.

KW - Anti-TNFα

KW - Corticosteroids

KW - Inflammatory bowel diseases

KW - Therapy

KW - Venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=85046542850&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046542850&partnerID=8YFLogxK

U2 - 10.1093/ecco-jcc/jjx162

DO - 10.1093/ecco-jcc/jjx162

M3 - Review article

C2 - 29220427

AN - SCOPUS:85046542850

VL - 12

SP - 489

EP - 498

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

IS - 4

ER -