| Background:Though tumor necrosis factor inhibitor therapy is not the first line of therapy; its priority is to maintain remission, mucosal healing and improved quality of life. Currently available anti TNF alpha are such as infliximab, adalimumab, certolizumabpegol, golimumab. The treatment of biologic agents significantly modifies the immune system, increasing the risk of reactivation or development of tuberculosis and other severe infections such as viral hepatitis, malignancy, skin diseases, and drug induced systemic lupus erythematous-like syndromes and demyelinating diseases. The purpose of this study was to investigate the risk of incidence of latent tuberculosis prior and during the IBD patients treatment with anti-TNF alpha agents.Methods:A systematic literature search from 2003 to 2015 in search engines such as the Cochrane library, Pub-Med, EMbase, and BMJ Best Practice, Google scholar, Annals Gastroenterology, JCC journal was carried out to find out the relevant data. We designed a meta-analysis of the random effects model to assess the change in sequence of the outcome variable. Odd ratio and heterogeneity were analyzed using a random effects model, if P<0.05 the heterogeneity is significant.Results:We retrieved 923 citations and 16 studies including full article and abstracts selected for the meta-analysis. A selected of 12 studies analyses the risk of reactivation and newly developed tuberculosis infection with prophylaxis treatment and non-prophylaxis in anti TNF-a agent therapy was assessed, a fixed effects models using instead of the random effect model since heterogeneity I2:47.6%; forest plot is provided in table 2 and figure 2. Pooled estimate of 95% CI= 7.83 (4.44,13.79), P= <0.033 indicating the statistical significance of the study which reduce reactivation who had positive LTBI and given prophylaxis therapy, also there still lower probability of developing tuberculosis from negative test LTBI during the treatment of anti-TNF alpha. Incidence of occurring tuberculosis may vary according to prevalence region. In the study of Latent tuberculosis infection prior to TNF-a inhibitor therapy, we omitted 2 studies from total 16 studies by reason of not meeting the inclusion for calculation of LTBI. All the 14 studies individually show significant infection of tuberculosis. Overall pooled estimate of 95%CI:0.14 (0.11,0.18), P=<0.05 indicating the statistical results of 14 studies occurring tuberculosis test positive of various number of LTBI prior to TNF-a inhibitor therapy. In the study of latent tuberculosis after the treatment of TNF-a inhibitor therapy, Overall TB infection (reactivation and newly developed tuberculosis), was measured for all the studies and heterogeneity was analyzed using a random effects models. All the 16 studies individually show significant reduce reactivation of tuberculosis, overall pooled estimate of 95%CI:0.02(0.01-0.02) P<0.05 indicating the statistical significance of the study. Analysis for publication bias of funnel plot, Beggs and Eggers test shows possible publication bias, however a sensitivity analysis for asymmetric funnel plot results overall analyzed studies were stable.Conclusion:Despite the great effectiveness of anti-TNF-a treatment, they increase the risk of reactivating latent tuberculosis. Prior anti-TNF-a treatment, screening test of LTBI and prophylaxis reduce the reactivation of latent tuberculosis. Therefore clinician's should perceive the probable risks before initiation of biological agents. |
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