title: Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  We systematically reviewed infliximab benefit in reducing hospitalizations and/or major surgery rates in patients with inflammatory bowel disease (IBD).
  
  
  METHODS
  A literature search to May 2012 was performed to identify all studies (experimental and observational) evaluating patients with IBD treated with infliximab and providing data on hospitalizations and/or major surgery rates. Three reviewers independently performed studies' selection, quality assessment, and data extraction. Analyses were carried according to study design (randomized clinical trials [RCTs] and observational studies) and IBD type (Crohn's disease [CD] and ulcerative colitis [UC]). Random-effects meta-analysis was used to derive pooled and 95% confidence intervals (CIs) estimates of odds ratios (OR). Heterogeneity was assessed with I test.
  
  
  RESULTS
  Twenty-seven eligible studies were included (9 RCTs and 18 observational studies). Infliximab reduced hospitalization risk, both in pooled RCTs (OR, 0.51; 95% CI 0.40-0.65; I = 0%) and results of observational studies (OR, 0.29, 95% CI, 0.19-0.43; I = 87%), without differences between CD and UC. Infliximab reduced surgery risk in pooled RCTs results, both in CD (OR, 0.31; 95% CI, 0.15-0.64; I = 0%) and UC (OR, 0.57; 95% CI, 0.37-0.88; I = 0%). Pooled estimate from observational studies favored infliximab for patients with CD (OR, 0.32; 95% CI, 0.21-0.49; I = 77%), but not for patients with UC.
  
  
  CONCLUSIONS
  The best evidence available points toward a reduction of the risk of hospitalization and major surgery requirement in patients with IBD treated with infliximab. This impact is clinically and economically relevant because hospitalization and surgery are considered to be markers of disease severity and significantly contribute to the total direct costs associated with IBD.
authors.affiliation: Evidence-Based Medicine Centre, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Costa
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
authors.forename: Daniel
authors.initials: D
authors.lastname: Caldeira
authors.forename: Joana
authors.initials: J
authors.lastname: Alarcão
authors.forename: Rita
authors.initials: R
authors.lastname: Sousa
authors.forename: António
authors.initials: A
authors.lastname: Vaz-Carneiro
mesh_terms: D006801:Humans; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D006760:Hospitalization; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D000069285:Infliximab; D011379:Prognosis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab