Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: A meta-analysis.
OBJECTIVE
To determine whether continuation of tumor necrosis factor inhibitors (TNFi) before surgery increases the risk of surgical site infection (SSI) in rheumatoid arthritis (RA) patients.


METHODS
A systematic review of the literature was conducted from January 2000 to May first 2014, using the databases of PubMed, Cochrane review, Embase, and manual research of abstracts presented in scientific congresses. Most included studies were retrospective. We compared the risk of SSI in the case of discontinuation of TNFi versus continuing TNFi treatment before a surgery.


RESULTS
Six studies, with a total of 2743 patients (1360 in the group continuing TNFi agent and 1383 in the group discontinuing TNFi) were included. There was a decreased risk of SSI in patients stopping TNFi (relative risk [RR]=0.62 [95% confidence interval [CI] 0.43-0.89], P=0.99, I2=0%). Concerning overall complications, there was also a decreased risk in patients discontinuing TNFi treatment (RR=0.60 [95% CI 0.42-0.87], P=0.26, I2=25%).


CONCLUSIONS
This meta-analysis showed an increased risk of SSI in patients under TNF inhibitor, and a decreased risk of SSI in case of interruption of treatment during the perioperative time.
Grenoble Teaching Hospital, Hopital Sud, Rheumatology department, avenue de Kimberley, 38130 Echirolles cedex, France. Electronic address: mclay@chu-grenoble.fr.
Marine
M
Clay
Grenoble Teaching Hospital, Hopital Sud, Rheumatology department, avenue de Kimberley, 38130 Echirolles cedex, France.
Arnaud
A
Mazouyes
Grenoble Teaching Hospital, Hopital Sud, Rheumatology department, avenue de Kimberley, 38130 Echirolles cedex, France.
Melanie
M
Gilson
Grenoble Teaching Hospital, Hopital Sud, Rheumatology department, avenue de Kimberley, 38130 Echirolles cedex, France; GREPI, AGIM UJF CNRS FRE 3405, 38706 La Tronche, France.
Philippe
P
Gaudin
Grenoble Teaching Hospital, Hopital Sud, Rheumatology department, avenue de Kimberley, 38130 Echirolles cedex, France; GREPI, AGIM UJF CNRS FRE 3405, 38706 La Tronche, France.
Athan
A
Baillet
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
Rheumatoid arthritis; Surgery; Surgical site infection; TNF-α inhibitor