European Journal of Clinical Pharmacology

, Volume 69, Issue 11, pp 1891–1899

Elevated risk of opportunistic viral infection in patients with Crohn’s disease during biological therapies: a meta analysis of randomized controlled trials

  • Xiaobing Wang
  • Feng Zhou
  • Junzhang Zhao
  • Rui Zhou
  • Meifang Huang
  • Jin Li
  • Wei Wang
  • Shufang Xu
  • Bing Xia
Clinical Trial

DOI: 10.1007/s00228-013-1559-8

Cite this article as:
Wang, X., Zhou, F., Zhao, J. et al. Eur J Clin Pharmacol (2013) 69: 1891. doi:10.1007/s00228-013-1559-8

Abstract

Background

Biological agents have been widely used in the treatment of Crohn’s disease (CD). These drugs carry the risk of excessive immunosuppression, indicating possible opportunistic infections including opportunistic viral infections, but no meta analysis has ever focused on this issue.

Purpose

To evaluate whether there is an association between biological agents therapy and the risk of opportunistic viral infections and serious infections in patients with CD.

Methods

A search of online databases was performed and literature selection was carried out according to the inclusion and exclusion criteria by reading titles, abstracts and full texts. Study heterogeneity and publication bias were assessed. Whether to choose a fixed effects model or a random effects model depended on the result of heterogeneity test.

Results

There was a statistical significance in opportunistic viral infection events between the biological agents group and the placebo group. However, our analysis didn’t observe statistically significant differences between the two groups when combined analyses were carried out for herpes zoster and herpes simplex separately. A risk trend in the biological agents group was observed in the analysis for herpes zoster. More analyses aimed at the outcome measures and including influenza and serious infection were carried out separately, but no statistical significance was found in them.

Conclusion

Biological agents use might increase the risk of opportunistic viral infections in patients with CD, but not the risk of herpes simplex and serious infections. More randomized controlled trials (RCTs) are needed to draw the conclusion of whether they could elevate the risk of herpes zoster.

Keywords

Opportunistic viral infectionCrohn’s diseaseBiological therapiesMeta analysis

Supplementary material

228_2013_1559_Fig5_ESM.jpg (48 kb)
ESM FigureS1

The forest plot of randomized controlled trials of biological agents versus placebo in herpes zoster events in CD (JPEG 47 kb)

228_2013_1559_MOESM1_ESM.tif (8.1 mb)
High resolution image (TIFF 8285 kb)
228_2013_1559_Fig6_ESM.jpg (52 kb)
ESM FigureS2

The forest plot of randomized controlled trials of biological agents versus placebo in herpes simplex events in CD (JPEG 51 kb)

228_2013_1559_MOESM2_ESM.tif (8.9 mb)
High resolution image (TIFF 9122 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Xiaobing Wang
    • 1
    • 2
  • Feng Zhou
    • 1
    • 2
  • Junzhang Zhao
    • 1
    • 2
  • Rui Zhou
    • 1
    • 2
  • Meifang Huang
    • 1
    • 2
  • Jin Li
    • 1
    • 2
  • Wei Wang
    • 1
    • 2
  • Shufang Xu
    • 1
    • 2
  • Bing Xia
    • 1
    • 2
  1. 1.Department of Gastroenterology /HepatologyZhongnan Hospital of Wuhan UniversityWuhanPeople’s Republic of China
  2. 2.The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal DiseasesWuhanPeople’s Republic of China