Systematic review with meta-analysis.pdf

Alimentary Pharmacology and Therapeutics
Systematic review with meta-analysis: malignancies with
anti-tumour necrosis factor-a therapy in inflammatory bowel
disease
C. J. M. Williams*, L. Peyrin-Biroulet†& A. C. Ford*,‡
*Leeds Gastroenterology Institute, SUMMARY
St. James’ University Hospital, Leeds,
UK.
†Department of Background
Hepatogastroenterology, Inserm Anti-tumour necrosis factor-a (TNFa) antibodies are efficacious in inflammatory
U954, Nancy University Hospital, bowel disease (IBD). These drugs carry the theoretical risk of malignancy, particu-
Vandoeuvre-les-Nancy, France. larly lymphoma, but no systematic review and meta-analysis has examined this
‡Leeds Institute of Molecular
Medicine, University of Leeds, Leeds, issue.
UK.
Aim
To pool data from all available placebo-controlled studies to estimate risk of malig-
Correspondence to:
nancy with anti-TNFa therapy in IBD.
Dr A. C. Ford, Leeds Gastroenterology
Institute, 4th Floor, Bexley Wing, St.
James’ University Hospital, Beckett Methods
Street, Leeds, LS9 7TF, UK. MEDLINE, EMBASE and the Cochrane central register of controlled trials were
E-mail: alexf12399@ searched to November 2013. Randomised controlled trials (RCTs) comparing anti-
TNFa therapy with placebo in adults with Crohn’s disease (CD) or ulcerative
Publication data colitis (UC) were eligible. Data were pooled to obtain a relative risk (RR) of malig-
Submitted 14 December 2013 nancy with a 95% confidence interval (CI).
First decision 23 December 2013
Resubmitted 23 December 2013 Results
Accepted 28 December 2013 The search strategy identified 25 338 citations, of which 22 RCTs were eligible (11
EV Pub Online 20 January 2014
infliximab, six adalimumab, four certolizumab and one golimumab) involving 7054
As part of AP&T’s peer-review process, a patients (4566 CD and 2488 UC). In total, there were 16 (%) malignancies in
technical check of this meta-analysis was 4135 IBD patients allocated to anti-TNFa, compared