TNF-alpha inhibitors

Caesarean

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.
S4891
R12905
Broms (Controls exposed to other treatments), 2020 Caesarean section during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No 1.51 [1.30;1.76]
excluded (control group)
-/-   -/- - -
ref
S4890
R12897
Broms (Controls unexposed, disease free), 2020 Caesarean section 3 months (or more) before pregnancy or during pregnancy excluded population based cohort retrospective unexposed, disease free Adjustment: No 2.88 [2.54;3.27] C
excluded (exposition period)
387/1,027   281,654/1,623,483 282,041 1,027
ref
S4958
R12998
De Lorenzo (Controls unexposed, disease free), 2020 Caesarean at least 1st trimester retrospective cohort unexposed, disease free excluded Adjustment: No 4.20 [1.06;16.58] C
excluded (control group)
7/12   9/36 16 12
ref
S4959
R13004
De Lorenzo (Controls unexposed, sick), 2020 Caesarean at least 1st trimester excluded retrospective cohort unexposed, sick Adjustment: No 2.05 [0.53;7.87] C
excluded (exposition period)
7/12   13/32 20 12
ref
S4995
R13089
Drechsel, 2020 Caesarean section 1st trimester excluded prospective cohort unexposed, sick Adjustment: No 1.40 [0.43;4.53] C
excluded (exposition period)
6/14   23/66 29 14
ref
S3072
R4705
Duricova, 2019 Cesarean section during pregnancy (anytime or not specified) retrospective cohort unexposed, disease free Adjustment: No 10.55 [4.69;23.70] C 48/72   11/69 59 72
ref
S3066
R4665
Chaparro, 2018 Cesarean section 3 months (or more) before pregnancy or during pregnancy excluded retrospective cohort unexposed, sick Adjustment: No 1.66 [1.25;2.19] C
excluded (exposition period)
170/388   145/453 315 388
ref
S4898
R12944
Zbinden (rheumatoid arthritis), 2018 C-section during pregnancy (anytime or not specified) prospective cohort unexposed, disease free Adjustment: Yes 0.60 [0.20;1.50] -/28   -/70 - 28
ref
S4899
R12948
Zbinden b (axial spondyloarthritis), 2018 C-section during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: Yes 0.90 [0.31;2.40]
excluded (control group)
-/31   -/70 - 31
ref
S3070
R4689
De Lima (Controls unexposed, disease free), 2016 Caesarean section during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 6.30 [3.88;10.23] C
excluded (control group)
37/83   91/804 128 83
ref
S3071
R4698
De Lima (Treatment stopped during pregnancy, sick), 2016 Caesarean section 1st and 2nd trimester excluded prospective cohort unexposed, sick Adjustment: No 0.62 [0.25;1.54] C
excluded (exposition period)
12/32   25/51 37 32
ref
S2897
R4082
Diav-Citrin (Controls exposed to other treatments), 2014 Cesarean section 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No 1.50 [0.72;3.11] C
excluded (control group)
22/66   19/76 41 66
ref
S2893
R4074
Diav-Citrin (Controls unexposed, disease free), 2014 Cesarean section 1st trimester excluded prospective cohort unexposed, disease free Adjustment: No 1.44 [0.82;2.54] C
excluded (exposition period)
22/66   84/326 106 66
ref
Total 2 studies 2.56 [0.15;42.43] 59 100
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 Duricova, 2019Duricova, 2019 10.55[4.69; 23.70]597251%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Zbinden (rheumatoid arthritis), 2018Zbinden, 2018 1 0.60[0.20; 1.50]-2849%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (2 studies) I2 = 95% 2.56[0.15; 42.43]591000.250.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: rheumatoid arthritis;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 2.56[0.15; 42.43]5910095%NADuricova, 2019 Zbinden (rheumatoid arthritis), 2018 2 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.56[0.15; 42.43]5910095%NADuricova, 2019 Zbinden (rheumatoid arthritis), 2018 2 Tags Adjustment   - No  - No 10.55[4.69; 23.70]5972 -NADuricova, 2019 1   - Yes  - Yes 0.60[0.22; 1.64]-28 -NAZbinden (rheumatoid arthritis), 2018 1 All studiesAll studies 2.56[0.15; 42.43]5910095%NADuricova, 2019 Zbinden (rheumatoid arthritis), 2018 20.250.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

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

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

Sub-groups analysis using all included studies

excluded 2897, 3070, 4899, 4891, 4958

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 2.57[0.72; 9.16]18721490%NADuricova, 2019 Zbinden (rheumatoid arthritis), 2018 Zbinden b (axial spondyloarthritis), 2018 De Lima (Controls unexposed, disease free), 2016 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.51[1.30; 1.76]-- -NABroms (Controls exposed to other treatments), 2020 10.510.01.0