Post-operative outcomes in patients undergoing abdominal surgery for Crohn's disease treated with pre-operative Ustekinumab: A systematic review and meta-analysis

Abstract

Background: Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23 to treat Crohn's disease. Effects on surgical complications and outcomes are not well understood. Objectives: We aimed to assess the impact of pre-operative Ustekinumab on post-operative complications in patients with Crohn's disease undergoing abdominal surgery and compare to anti-tumor necrosis factor inhibitors (Anti-TNFs). Design: Systematic review and meta-analysis. Patient and Methods: We searched Medline (Ovid), The Cochrane Library (Wiley), EMBASE (Elsevier), Web of Science (Thomson Reuters), and Scopus (Elsevier), and CINAHL Plus with Full Text (Ebsco) for studies reporting rates of post-operative complications in Ustekinumab treated patients with Crohn's disease. Main Outcome Measure: Surgical site complications (SSI) and overall infectious complications between patients exposed to Ustekinumab pre-operatively in comparison to patients exposed to anti-TNFs pre-operatively. Sample Size: 6 studies including 650 patients. Results: Four out of six studies reported data for post-operative infectious complications between Ustekinumab and anti-TNFs. Among a total of 107 patients who received Ustekinumab and 543 patients who received anti-TNFs, there was no significant difference between the two groups in terms of total infectious complications (RR 1.30, 95% CI 00.54-3.12; P = 0.55). Three studies, including 102 patients in the Ustekinumab group and 481 patients in the anti-TNF alpha group, reported surgical site infections. No significant difference was observed between the two groups (RR 0.75, 95% CI 0.36-1.58; P=0.45). Conclusion: Pre-operative Ustekinumab use was not associated with reduced post-operative complication rates as compared to anti-TNFs in patients with Crohn's disease undergoing abdominal surgery, but there was substantial heterogeneity between trials. Limitations: Data heterogeneity, incomplete data from some of the studies. Conflict of Interest: None.