Safety Analysis of Preoperative Anti-TNF-alpha Therapy in Pediatric IBD After Intestinal Resection: A Systematic Review and Meta-analysis

Background: Biological agents have transformed the management of inflammatory bowel disease (IBD). However, intestinal resection is still unavoidable in complicated IBD. It is still under debate whether antitumor necrosis factor (TNF)-alpha is related to higher postoperative complications in children with IBD. Therefore, we aimed to analyze data on preoperative anti-TNF-alpha and postoperative complications in pediatric IBD.Methods: We conducted a systematic literature search in 4 databases for studies that compared the incidence of postoperative complications between children with IBD who received anti-TNF-alpha treatment within 12 weeks prior to intestinal resection and who did not receive anti-TNF-alpha before the operation. To analyze this question, pooled odds ratios (ORs) were calculated with 95% confidence intervals (CIs). Odds ratios higher than 1 mean higher complication rate among children treated with preoperative anti-TNF-alpha, whereas an OR lower than 1 means lower complication rate. The I-2 value was calculated to measure the strength of the between-study heterogeneity, where a smaller percentage means the lower heterogeneity.Results: We found 8 eligible articles with 526 pediatric patients with IBD. The primary outcome was the overall complication. The pooled OR of overall complications was 1.38 (95% CI, 0.10-18.76; P = .65; I-2 = 34%) in contrast, the OR of infectious and noninfectious complications were 0.59 (95% CI, 0.21-1.69; P = .16; I-2 = 0%) and 0.48 (95% CI, 0.18-1.25; p = .09; I-2 = 0%), although both showed a nonsignificant result.Conclusion: There is no significant association between preoperative anti-TNF-alpha therapy and postoperative complications in children with IBD after intestinal resection. However, the evidence is low due to the low number of studies investigating this question.