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Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2017/09  
 
  2017 Sep;112(9):1423-1429  
  doi: 10.1038/ajg.2017.201  
 
  Risk of Postoperative Complications Among Inflammatory Bowel Disease Patients Treated Preoperatively With Vedolizumab  
 
  Yamada A, Komaki Y, Patel N, Komaki F, Aelvoet AS, Tran AL, Pekow J, Dalal S, Cohen RD, Cannon L, Umanskiy K, Smith R, Hurst R, Hyman N, Rubin DT, Sakuraba A  
  https://www.ncbi.nlm.nih.gov/pubmed/28719595  
 
 

Abstract

OBJECTIVES:

Vedolizumab is increasingly used to treat patients with ulcerative colitis (UC) and Crohn's disease (CD), however, its safety during the perioperative period remains unclear. We compared the 30-day postoperative complications among patients treated preoperatively with vedolizumab, anti-tumor necrosis factor (TNF)-α agents or non-biological therapy.

METHODS:

The retrospective study cohort was comprised of patients receiving vedolizumab, anti-TNF-α agents or non-biological therapy within 4 weeks of surgery. The rates of 30-day postoperative complications were compared between groups using univariate and multivariate analysis. Propensity score-matched analysis was performed to compare the outcome between groups.

RESULTS:

Among 443 patients (64 vedolizumab, 129 anti-TNF-α agents, and 250 non-biological therapy), a total of 144 patients experienced postoperative complications (32%). In multivariate analysis, age >65 (odds ratio (OR) 3.56, 95% confidence interval (CI) 1.30-9.76) and low-albumin (OR 2.26, 95% CI 1.28-4.00) were associated with increased risk of 30-day postoperative complications. For infectious complications, steroid use (OR 3.67, 95% CI 1.57-8.57, P=0.003) and low hemoglobin (OR 3.03, 95% CI 1.32-6.96, P=0.009) were associated with increased risk in multivariate analysis. Propensity score matched analysis demonstrated that the risks of postoperative complications were not different among patients preoperatively receiving vedolizumab, anti-TNF-α agents or non-biological therapy (UC, P=0.40; CD, P=0.35).

CONCLUSIONS:

In the present study, preoperative vedolizumab exposure did not affect the risk of 30-day postoperative complications in UC and CD. Further, larger studies are required to confirm our findings.

 
 
Question posée
 
Le vedolizumab en pré-opératoire est-il associé à sur-risque de complication post-opératoire dans les MICI ?
 
Question posée
 
Le risque de complication post opératoire n’était pas différent dans les groupes recevant en préopératoire du vedolizumab, des anti-TNF ou des traitements non biologiques.
 
Commentaires

Ces données devront être confirmées par de plus larges études. 

 
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