S791 Impact of Biologic Therapies on Risk of Major Adverse Cardiovascular Events in Crohn’s Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Notice bibliographique
Résumé
Introduction: Biologic therapies are efficacious in inducing response and remission in patients with moderate to severe Crohn’s Disease (CD); however, no previous systematic reviews investigated risk of major adverse cardiovascular events (MACEs). The aim of this systematic review and meta-analysis is to estimate the risk of MACEs in adult patients with CD treated with biologic therapies. Methods: We systematically searched Medline, Cochrane Central Register of Controlled Trials, Scopus, and Embase databases up to March 2022 to identify eligible studies that assessed the risk of MACEs in adult patients (age ≥18 years) with CD on biologic therapies. Only phase 3, active-comparator or placebo controlled randomized trials (RCTs) were included in the analysis. Our primary outcome was the rate of MACEs observed in patients receiving biologic therapies during induction and maintenance phases of RCTs. Random effects model was used to calculate pooled odds ratios (ORs) and 95% CIs and I2 statistics was used to assess heterogeneity. Results: Twenty-nine RCTs involving 12196 patients with CD were included in our systematic review and meta-analysis. There was no evidence of statistical heterogeneity across the studies using the I2 statistic (I2=0). Biologic therapies were not associated with increased risk of MACEs during induction [infliximab (OR 0.63, 95% CI 0.07–6.14), adalimumab (OR 0.72, 95% CI 0.07–6.96), ustekinumab (OR 0.50, 95% CI 0.03–8.04), natalizumab (OR 0.50, 95% CI 0.05–4.86), vedolizumab (OR 0.53, 95% CI 0.06–5.12), certolizumab (OR 1.90, 95% CI 0.16–22.76) and risankizumab (OR 0.34, 95% CI 0.01–17.12)]. Additionally, there was no statistically significant difference in risk of MACEs associated with the use of biologic therapies during maintenance compared to placebo [infliximab (OR 0.72, 95% CI 0.01–5.10), adalimumab (OR 0.80, 95% CI 0.08–7.77), ustekinumab (OR 1.53, 95% CI 0.06–37.71), natalizumab (OR 1.02, 95% CI 0.02–51.59), vedolizumab (OR 0.70 95% CI 0.04–11.53), and certolizumab (OR 1.91, 95% CI 0.16–22.83]. Conclusion: Although pervious systematic reviews have studied the efficacy of biologic therapies in CD, major adverse cardiovascular events (MACEs), which are important safety outcomes, have not been addressed. In our study, we found that the use of biologic therapies among adult patients with Crohn’s disease was not associated with increased risk of MACEs. However, patient level data were lacking and meta-regression analyses were not performed to adjust for confounding factors. (Figure)Figure 1.: A. Forest plot showing risk of MACEs in patients receiving biologic therapies for the induction of remission in randomized controlled trials B. Forest plot showing risk of MACEs in patients receiving biologic therapies for the maintenance of remission in randomized controlled trials
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 | 0,024 | 0,067 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,022 | 0,043 |
| Bibliométrie | 0,010 | 0,010 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| 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 ».