TNF-alpha inhibitors

Neonatal infections

R analysis
id Study   Lib. in paper Exposition period    Study type  Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S4995
R13093
Drechsel, 2020 Neonatal infection (follow up 6 months of age) 1st trimester prospective cohort unexposed, sick Adjustment: No 0.94 [0.04;20.73] C 0/14   2/66 2 14
ref
S4952
R12992
Moens (Controls exposed to Vedolizumab), 2020 Infections during the first year of life at least 1st trimester retrospective cohort exposed to other treatment, sick excluded Adjustment: No 2.37 [0.59;9.61] C
excluded (control group)
7/67   3/64 10 67
ref
S4951
R12987
Moens (Controls unexposed, sick), 2020 Infections during the first year of life at least 1st trimester retrospective cohort unexposed, sick Adjustment: No 0.87 [0.29;2.63] C 7/67   7/59 14 67
ref
S3072
R4709
Duricova, 2019 Infection complications (within 1 year of life) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free Adjustment: Yes 0.86 [0.32;2.32] -/72   -/69 - 72
ref
S3123
R8744
De Lima, 2018 Number of infections treated with systemic antibiotics during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 1.09 [0.19;6.20] C 4/15   3/12 7 15
ref
S3093
R4777
Luu, 2018 All infections children (0-1 year) 3rd trimester retrospective cohort (claims database) exposed to other treatment, sick 3rd trimester exposure Adjustment: Yes 0.89 [0.76;1.05] -/716   -/4,444 - 716
ref
S3076
R4723
Vinet (Controls unexposed, disease free), 2018 Serious infections in the offspring (≥1 hospitalization with infection within the first 12 months of life) during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free excluded Adjustment: Yes 1.70 [0.80;3.70]
excluded (control group)
12/380   279/14,596 291 380
ref
S3077
R4727
Vinet (Controls unexposed, sick), 2018 Serious infections in the offspring (≥1 hospitalization with infection within the first 12 months of life) 3rd trimester retrospective cohort unexposed, sick Adjustment: Yes 1.40 [0.50;3.60] 5/156   49/2,476 54 156
ref
S3070
R4693
De Lima (Controls unexposed, disease free), 2016 Infections requiring antibiotics (in the first year of life) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 0.47 [0.24;0.89] C
excluded (control group)
13/55   183/459 196 55
ref
S3071
R4702
De Lima (Treatment stopped during pregnancy, sick), 2016 Infections requiring antibiotics (in the first year of life) 1st and 2nd trimester prospective cohort unexposed, sick Adjustment: No 0.65 [0.21;2.04] C 7/24   12/31 19 24
ref
S3037
R4574
Seirafi, 2014 Infections in newborn (up to week 8 post-partum) 3 months (or more) before pregnancy or during pregnancy excluded retrospective cohort unexposed, sick Adjustment: No before conception and/or during pregnancy 1.53 [0.14;17.19] C
excluded (exposition period)
2/118   1/90 3 118
ref
Total 7 studies 0.90 [0.77;1.04] 96 1,064
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Drechsel, 2020Drechsel, 2020 0.94[0.04; 20.73]2140%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Moens (Controls unexposed, sick), 2020Moens, 2020 1 0.87[0.29; 2.63]14672%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Duricova, 2019Duricova, 2019 0.86[0.32; 2.32]-722%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA De Lima, 2018De Lima, 2018 1.09[0.19; 6.20]7151%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Luu, 2018Luu, 2018 0.89[0.76; 1.05]-71690%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Vinet (Controls unexposed, sick), 2018Vinet, 2018 2 1.40[0.50; 3.60]541562%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA De Lima (Treatment stopped during pregnancy, sick), 2016De Lima, 2016 3 0.65[0.21; 2.04]19242%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (7 studies) I2 = 0% 0.90[0.77; 1.04]961,0640.25.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Controls unexposed, sick; 3: Treatment stopped during pregnancy, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.90[0.77; 1.04]961,0640%criticalDrechsel, 2020 Moens (Controls unexposed, sick), 2020 Duricova, 2019 De Lima, 2018 Luu, 2018 Vinet (Controls unexposed, sick), 2018 De Lima (Treatment stopped during pregnancy, sick), 2016 7 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 0.86[0.32; 2.32]-72 -criticalDuricova, 2019 1 unexposed, sickunexposed, sick 0.96[0.52; 1.76]892610%criticalDrechsel, 2020 Moens (Controls unexposed, sick), 2020 Vinet (Controls unexposed, sick), 2018 De Lima (Treatment stopped during pregnancy, sick), 2016 4 exposed to other treatment, sickexposed to other treatment, sick 0.89[0.76; 1.05]77310%criticalDe Lima, 2018 Luu, 2018 2 Tags 3rd trimester exposure3rd trimester exposure 0.89[0.76; 1.05]-716 -criticalLuu, 2018 1 Adjustment   - No  - No 0.81[0.40; 1.64]421200%criticalDrechsel, 2020 Moens (Controls unexposed, sick), 2020 De Lima, 2018 De Lima (Treatment stopped during pregnancy, sick), 2016 4   - Yes  - Yes 0.90[0.77; 1.05]549440%criticalDuricova, 2019 Luu, 2018 Vinet (Controls unexposed, sick), 2018 3 All studiesAll studies 0.90[0.77; 1.04]961,0640%criticalDrechsel, 2020 Moens (Controls unexposed, sick), 2020 Duricova, 2019 De Lima, 2018 Luu, 2018 Vinet (Controls unexposed, sick), 2018 De Lima (Treatment stopped during pregnancy, sick), 2016 70.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.73.61.8940.000Drechsel, 2020Moens (Controls unexposed, sick), 2020Duricova, 2019De Lima, 2018Luu, 2018Vinet (Controls unexposed, sick), 2018De Lima (Treatment stopped during pregnancy, sick), 2016

Asymetry test p-value = 0.7021 (by Egger's regression)

slope=-0.1231 (0.0478); intercept=0.0934 (0.2304); t=0.4052; p=0.7021

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 3070, 3076, 4952

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.86[0.38; 1.95]48750769%NADuricova, 2019 Vinet (Controls unexposed, disease free), 2018 De Lima (Controls unexposed, disease free), 2016 3 unexposed, sick controlsunexposed, sick controls 0.96[0.52; 1.76]892610%NADrechsel, 2020 Moens (Controls unexposed, sick), 2020 Vinet (Controls unexposed, sick), 2018 De Lima (Treatment stopped during pregnancy, sick), 2016 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.90[0.77; 1.06]177980%NAMoens (Controls exposed to Vedolizumab), 2020 De Lima, 2018 Luu, 2018 30.510.01.0