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Chen W, Liu Y, Zhang Y, Zhang H, Chen C, Zhu S, Zhou Y, Zhao H, Zong Y. Risk of Clostridioides difficile infection in inflammatory bowel disease patients undergoing vedolizumab treatment: a systematic review and meta-analysis. BMC Gastroenterol 2024; 24:377. [PMID: 39448963 PMCID: PMC11515399 DOI: 10.1186/s12876-024-03460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic, relapsing condition wherein biologics have improved disease prognosis but introduced elevated infection susceptibility. Vedolizumab (VDZ) demonstrates unique safety advantages; however, a comprehensive systematic comparison regarding the risk of Clostridioides difficile infection (CDI) between vedolizumab and alternative medications remains absent. METHOD Medline, Embase, Cochrane, and clinicaltrials.gov registry were comprehensively searched. Pooled estimates of CDI proportion, incidence, pooled risk ratio between ulcerative colitis (UC) and Crohn's disease (CD), vedolizumab and other medications were calculated. Data synthesis was completed in R using the package "meta". RESULTS Of the 338 studies initially identified, 30 met the inclusion/exclusion criteria. For CDI risk, the pooled proportion was 0.013 (95% CI 0.010-0.017), as well as the pooled proportion of serious CDI was 0.004 (95% CI 0.002-0.008). The comparative pooled risk ratios revealed: UC versus CD at 2.25 (95% CI 1.73-2.92), vedolizumab versus anti-TNF agents at 0.15 (95% CI 0.04-0.63) for UC and 1.29 (95% CI 0.41-4.04) for CD. CONCLUSION The overall CDI risk in IBD patients exposed to vedolizumab was estimated to be 0.013. An increased risk of CDI was noted in UC patients receiving vedolizumab compared to those with CD. Vedolizumab potentially offers an advantage over anti-TNF agents for UC regarding CDI risk, but not for CD. TRIAL REGISTRATION The study was registered on the PROSPERO registry (CRD42023465986).
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Affiliation(s)
- Wei Chen
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China
| | - Yuhang Liu
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China
| | - Yuelun Zhang
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhang
- Wenzhou Integrated Traditional Chinese and Western Medicine Hospital Pharmacy Department, Wenzhou, Zhejiang Province, China
| | - Chuyan Chen
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China
| | - Siying Zhu
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China
| | - Yanhua Zhou
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China
| | - Haiying Zhao
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China
| | - Ye Zong
- Department of Gastroenterology, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, National Clinical Research Center for Digestive Disease, Capital Medical University, 95 Yong-an Road, Xi- cheng District, Beijing, China.
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