Thiopurines (Azathioprine, Mercaptopurin) updated on 07-28-2025

Limb defects

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.
S17723
R74780		 Meyer, 2025 Limb malformations 1st trimester population based cohort retrospective unexposed, sick Adjustment: Yes Indications: Inflammatory Bowel disease (IBD) 1.03 [0.57;1.83] 14/5,223   74/28,827 88 5,223
ref
S6698
R19117		 Alami, 2017 Skeletal defects at least 1st trimester prospective cohort unexposed, sick Adjustment: No Indications: Any or not specified 5.85 [0.28;123.31] C 2/97   0/111 2 97
ref
S13582
R52652		 Ban (Controls unexposed, disease free), 2014 Limb defects 1st trimester retrospective cohort (claims database) unexposed, disease free excluded Adjustment: No Indications: Inflammatory Bowel disease (IBD) 0.63 [0.04;10.05] C
excluded (control group) 		0/149   2,059/384,811 2,059 149
ref
S11392
R44250		 Ban (Controls unexposed, sick), 2014 Limb defects 1st trimester retrospective cohort (claims database) unexposed, sick Adjustment: No Indications: Inflammatory Bowel disease (IBD) 0.95 [0.05;17.23] C 0/149   5/1,554 5 149
ref
Total 3 studies 1.09 [0.62;1.91] 95 5,469
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 Meyer, 2025Meyer, 2025 1.03[0.57; 1.83]885,22393%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Alami, 2017Alami, 2017 5.85[0.28; 123.31]2973%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Ban (Controls unexposed, sick), 2014Ban, 2014 1 0.95[0.05; 17.23]51494%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: unclearROB reporting: moderate Total (3 studies) I2 = 0% 1.09[0.62; 1.91]955,4690.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.09[0.62; 1.91]955,4690%NAMeyer, 2025 Alami, 2017 Ban (Controls unexposed, sick), 2014 3 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 1.09[0.62; 1.91]955,4690%NAMeyer, 2025 Alami, 2017 Ban (Controls unexposed, sick), 2014 3 Tags Adjustment   - No  - No 2.25[0.28; 18.39]72460%NAAlami, 2017 Ban (Controls unexposed, sick), 2014 2   - Yes  - Yes 1.03[0.57; 1.85]885,223 -NAMeyer, 2025 1 Indications   - Any or not specified  - Any or not specified 5.85[0.28; 123.31]297 -NAAlami, 2017 1   - Inflammatory Bowel disease (IBD)  - Inflammatory Bowel disease (IBD) 1.03[0.58; 1.82]935,3720%NAMeyer, 2025 Ban (Controls unexposed, sick), 2014 2 All studiesAll studies 1.09[0.62; 1.91]955,4690%NAMeyer, 2025 Alami, 2017 Ban (Controls unexposed, sick), 2014 30.220.01.0

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 13582

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.63[0.04; 10.05]2,059149 -NABan (Controls unexposed, disease free), 2014 1 unexposed, sick controlsunexposed, sick controls 1.09[0.62; 1.91]955,4690%NAMeyer, 2025 Alami, 2017 Ban (Controls unexposed, sick), 2014 30.510.01.0