Management of biologics in oral surgery | Journal of Oral Medicine and Oral Surgery

Open Access

Table II

Summary of studies comparing risk of postoperative infection in patients on biological therapy [9, 11–38].

Study	Population	Sample size	Biologic therapy	Type of surgery	Comparator groups	Results
Abou Zahr et al.²⁰ (2015)	Rheumatoid arthritis	896	Various	Various	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Increased infection rates with continued biologics but did not reach statistical significance
Bafford et al.²¹ (2013)	Crohn's disease	196	Various	Abdominal	Preoperative biologic use No preoperative biologic use	Similar infection rates
Bakkour et al.¹⁰ (2016)	Psoriasis, psoriatic arthritis	42	ADA, ETN, INF	Orthopaedic, cardiovascular, skin	Continued biologic therapy Interruption to biological therapy	Similar infection rates
Bibbo et al.²² (2004)	Rheumatoid arthritis	31	ETN, INF	Orthopaedic	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
Bongartz et al.²³ (2008)	Rheumatoid arthritis	50	ETN, INF, ADA	Orthopaedic	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
den Broeder et al.²⁴ (2007)	Rheumatoid arthritis	196	ETN, INF, ADA	Orthopaedic	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates but increased risk of wound healing complication with continued biologics (OR 11.2, 95% CI 1.4-90)
Cohen et al.²⁵ (2019)	Inflammatory bowel disease	955	Various	Abdominal	Biologic use within 12 weeks of surgery/detectable anti-TNF levels No biologic use within 12 weeks of surgery/undetectable anti-TNF levels	Similar infection rates
Gainsbury et al.²⁶ (2011)	Ulcerative colitis	81	INF	Abdominal	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
George et al.⁶ (2017)	Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease	4288	INF	Orthopaedic	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
George et al.²⁷ (2018)	Rheumatoid arthritis	1537	ABT	Orthopaedic	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
Giles et al.²⁸ (2006)	Rheumatoid arthritis	91	ETN, INF, ADA	Orthopaedic	Continued TNF⍺ inhibitor Continued conventional DMARDs	Increased risk of infection with continued biologics (p<0.05) OR 5.3 CI 1.1-24.9
Godot et al.²⁹ (2013)	Rheumatoid arthritis	140	RTX	Various	Postoperative complications No postoperative complications	Similar infection rates
Hirano et al.³⁰ (2009)	Rheumatoid arthritis	44	TCZ	Orthopaedic	Continued TNF⍺ inhibitor Continued conventional DMARDs	Similar infection rates
Hirano et al.³¹ (2010)	Rheumatoid arthritis	113	ETN, INF	Orthopaedic	Discontinued TNF⍺ inhibitor Continued conventional DMARDs	Similar infection rates
Holubar et al.³² (2021)	Inflammatory bowel disease	1562	Various	Abdominal	Biologic use within 60 days of surgery No biologic use within 60 days of surgery	Similar infection rates
Kawakami et al.³³ (2010)	Rheumatoid arthritis	128	ETN, INF	Orthopaedic	Continued TNF⍺ inhibitor Continued conventional DMARDs	Increased risk of infection with continued biologics (p<0.05) OR 21.8 CI 1.23-386.1
Kim et al.³⁴ (2018)	Ulcerative colitis	315	Various	Abdominal	Preoperative biologic use No preoperative biologic use	Similar infection rates
Kubota et al.³⁵ (2012)	Rheumatoid arthritis	554	INF, ETN, ADA, TCZ	Orthopaedic	Patients on biological therapy Patients not on biological therapy	Similar infection rates
Kunitake et al.³⁶ (2008)	Crohn's disease, ulcerative colitis	413	INF	Abdominal	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
Kulaylat et al.³⁷ (2021)	Crohn's disease	2364	Various	Abdominal	Biological therapy No biological therapy	Increased postoperative infection (OR 1.6; 95% CI, 1.2– 2.0)
Latourte et al.³⁸ (2017)	Rheumatoid arthritis	263	ABT	Various	Postoperative complications No postoperative complications	Similar infection rates
Lau et al.⁷ (2015)	Inflammatory bowel disease	331	INF, ADA, CTZ	Abdominal	Total serum level of TNFα inhibitor drug detected ≥ 0.98 µg/mL	Infectious complications significantly higher in the ≥ 3 µg/mL group (OR = 3.0, P = 0.03)
Marchal et al.³⁹ (2004)	Crohn's disease	79	INF	Abdominal	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
Mitsuya et al.⁴⁰ (2019)	Inflammatory bowel disease	62	INF, ADA, VDZ	Abdominal	Preoperative biologic use No preoperative biologic use	Similar infection rates
Momohara et al.⁴¹ (2011)	Rheumatoid arthritis	420	ENT, INF, ADA	Orthopaedic	Continued TNF⍺ inhibitor Continued conventional DMARDs	Increased risk of infection with continued biologics (p<0.05) OR 5.69 CI 2.07-15.6
Ruyssen-Witrand et al.⁴² (2005)	Rheumatoid arthritis, spondyloarthropathies, other	101	ETN, INF, ADA	Orthopaedic, abdominal, gynaecological	Discontinued TNF⍺ inhibitor <2 HL Discontinued TNF⍺ inhibitor 2-5 HL Discontinued TNF⍺ inhibitor >5 HL	Increased infection rates with continued biologics but did not reach statistical significance
Talwalker et al.⁴³ (2005)	Rheumatoid arthritis, psoriatic arthritis	16	ETN, INF, ADA	Orthopaedic	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates
Waterman et al.⁴⁴ (2013)	Inflammatory bowel disease	473	Various	Abdominal	Preoperative biologic use No preoperative biologic use	Similar infection rates
Wendling⁴⁵ (2007)	Rheumatoid arthritis	50	ETN, INF, ADA	Orthopaedic, abdominal, head and neck	Continued TNF⍺ inhibitor Discontinued TNF⍺ inhibitor	Similar infection rates

ABT = abatacept, ADA = adalimumab, CTZ = certolizumab pegol, ETN = etanercept, HL = half-life, INF = infliximab, OR = odds ratio, RTX = rituximab, TCZ = tocilizumab, VDZ = vedolizumab.

Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.

Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.

Initial download of the metrics may take a while.