Postoperative complications in patients with rheumatoid arthritis using a biological agent – A systematic review and meta-analysis

Abstract

Objectives. To evaluate, through a systematic review of the literature, the association between the use of biological disease-modifying antirheumatic drugs (bDMARDs) and surgical site infection (SSI) or wound healing delay after orthopedic surgery in patients with rheumatoid arthritis (RA).

Methods. A systematic review of articles indexed in the Cochrane Library, PubMed, and Web of Science from 1992 to 2012 was performed. The search aimed to identify studies describing SSI or wound healing delay in patients with RA treated with or without bDMARDs. Articles fulfilling the predefined inclusion criteria were reviewed systematically and their quality was appraised.

Results. There was no Cochrane review on this subject. We found 75 articles through specific searches of PubMed and Web of Science, and hand searching. After inclusion and exclusion by full-text review, 10 articles were found for SSI, and 5 articles for delayed wound healing. The use of bDMARDs appeared to increase the rate of SSI slightly, especially in large joint-replacement surgery. Delayed wound healing was not increased by the use of bDMARDs. However, the definitions of SSI and delayed wound healing varied between the reviewed articles. Most of the articles focused on tumor necrosis factor-α inhibitors.

Conclusion. bDMARDs slightly increase the relative risk of SSI but not that of delayed wound healing after orthopedic surgery and should be used with appropriate caution.

Keywords:

• Biological agent
• Delayed wound healing
• Perioperative complication
• Rheumatoid arthritis
• Surgical site infection
• Systematic review

Acknowledgments

This work was supported by Health and Labour Sciences Research Grants for Research on Allergic Disease and Immunology from the Ministry of Health, Labour and Welfare (Grant No.H23-Meneki-Shitei-016).

Conflict of interest

H.I. has received grant and research support from Takeda, Mitsubishi-Tanabe, Chugai, Pfizer, Astellas, and Daiichi-Sankyo; K.N. has received research funding from Abbvie, Astellas, Chugai, Mitsubishi-Tanabe, Eisai, and Bristol-Myers-Squibb; I.M. has received lecturer's fee from Takeda, Mitsubishi-Tanabe, Chugai, Pfizer, Astellas, Bristol-Myers-Squibb, AbbVie, and Eisai; T.K. received speakers’ bureau from Mitsubishi-Tanabe, Takeda, Eisai, Abbvie, Bristol-Myers-Squibb, Pfizer, Chugai, Janssen, and Astellas and research grants from Takeda, Janssen, and Astellas; Y.K. has received research honorarium for the lecture from Abbvie, Eisai, Chugai, Bristol-Myers-Squibb, Astellas, Mitsubishi-Tanabe, Pfizer, Janssen, and UCB; Y.K. has received honorarium for the lecture or consultancy from AbbVie, Asahikasei Pharma, Astellas, Bristol-Myers-Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Mitsubishi-Tanabe, Nippon Shinyaku, Ono Pharma, Pfizer, Takeda, UCB, and Santen and has received research grant from AbbVie, Asahikasei Pharma, Astellas, Bristol-Myers-Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Mitsubishi-Tanabe, Nippon Shinyaku, Ono Pharma, Pfizer, Taisho-Toyama, and Takeda.; M.K. received speaking fees and/or honoraria from Santen, Mitsubishi-Tanabe, Pfizer, Eisai, Teijin Pharma, and Ono Pharma; Y.S. has received speaker fee from AbbVie; N.K. received payments from StaGen, SRL, and Teijin Pharma; A.I. has received grant and research support from Pfizer, AbbVie, and Chugai; N.M. has received research grants from AbbVie, Astellas, Bristol-Myers-Squibb, Chugai, Dainihon-Sumitomo, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, Novartis, and Takeda and received consulting fee or honorarium from AbbVie, Bristol-Myers-Squibb, and Janssen; HY has received honorarium for the lecture or consultancy from Teijin Pharma, Chugai, Astellas, Bristol-Myers-Squibb, AbbVie, Daiichi-Sankyo, Nihon-Kayaku, Mitsubishi-Tanabe, Pfizer, Takeda, and UCB and has received research grant from AbbVie, Asahikasei Pharma, Astellas, Bristol-Myers-Squibb, Chugai, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Janssen, Mitsubishi-Tanabe, MSD, Nippon Kayaku, Pfizer, Santen, Taisho-Toyama, Takeda, and Teijin Pharma.; M.K., T.N., H.E., S.H., K.T., and M.H. declared that no conflict of interest exists. The sponsors were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of this manuscript; or in the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.