S765 Paternal Biologic and Thiopurine Exposure in Inflammatory Bowel Disease and Association With Adverse Pregnancy Outcomes and Semen Parameters: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: Studies evaluating reproductive outcomes in males with inflammatory bowel disease (IBD) are limited. We explored the association between biologic therapy and thiopurines in male patients with IBD and adverse pregnancy outcomes and semen parameters. Methods: We searched Medline, Embase, Scopus, and Web of Science (PROSPERO CRD42020197098) from inception to March 2021 for studies reporting adverse pregnancy outcomes and semen parameters in male IBD patients exposed to biologics. We also compared adverse pregnancy outcomes and semen parameters in biologic versus thiopurine users. Prevalence, standardized mean difference (SMD), and odds ratios (OR) of outcomes were pooled and analysed using a random effects model. Results: Eight studies reporting adverse pregnancy outcomes (735 IBD patients) and four studies with semen parameters (68 patients) with biologics (5 anti-TNF, 2 vedolizumab, 1 mixed exposure) were included. In patients exposed to biologics, the prevalence of adverse pregnancy outcomes was 4% for early pregnancy loss, 5% for preterm birth and 3% for congenital malformations. Biologic use did not result in impaired sperm count (SMD 0.21, I2 = 33.0%, P = 0.15), morphology (SMD 0.62, I2 = 83.0%, P = 0.08), motility (SMD 0.62, I2 = 84.0%, P = 0.09), or increased early pregnancy loss (OR 1.26, 95% 0.61-2.61, I2 = 0%), preterm birth (OR 1.10, 95% 0.96-1.26, I2 = 0%), or congenital malformations (OR 1.03, 95% 0.89-1.19, I2 = 0%). Five studies reporting adverse pregnancy outcomes (905 IBD patients) and three studies with semen parameters (95 male patients) with thiopurines were included. Thiopurine use was associated with increased sperm count (SMD 0.53, I2 = 0.0%, P < 0.001) but was not associated with impaired sperm motility (SMD 0.25, I2 = 83.0%, P = 0.08) or sperm morphology (SMD 0.30, I2 = 97%, P = 0.33). Thiopurine use in male patients with IBD was not associated with increased risk of early pregnancy loss (OR 1.13, 95% 0.89-1.94, I2 = 19%), preterm birth (OR 1.05, 95% 0.94-1.18, I2 = 0%), or congenital malformations (OR 1.07, 95% 0.93-1.23, I2 = 7%). Semen parameters and risk of adverse pregnancy outcomes did not differ between biologic versus thiopurine users. Conclusion: Biologic therapy (mostly anti-TNF) or thiopurine use in male patients with IBD is not associated with more prevalent adverse pregnancy outcomes or impairment in semen parameters. The safety profile of biologics appears to be comparable to thiopurines based on available evidence. Larger studies with vedolizumab and ustekinumab are needed.Figure 1.: Baseline variables associated with (A) live birth, (B) pregnancy loss, (C) preterm birth and (D) low birth weight from multivariate logistic regression analysis. The following baseline variables were evaluated in the multivariate logistic regression analyses if they included ≥10% of the population and there were patients both with and without the pregnancy outcome in question: maternal age (≤35 years/>35 years); indication for CZP treatment (rheumatoid arthritis, axial spondyloarthritis, Crohn’s disease); concomitant medications (systemic corticosteroids, NSAIDs, methotrexate/leflunomide); and maternal infections. Only variables identified as being significantly associated with the pregnancy outcome of interest are shown (p<0.05 for entry into the multivariate model and p≥0.1 for elimination). [a] Includes spontaneous miscarriages, and elective and medically indicated abortions. CI: confidence interval; CZP: certolizumab pegol; NSAID: non-steroidal anti-inflammatory drug; OR: odds ratio.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,014 | 0,029 |
| Bibliométrie | 0,007 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».