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

Late intrauterine deaths (> 22 weeks) / Stillbirths

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.
S13576
R52621		 Meyer b (Controls exposed to Anti-TNF), 2021 Stillbirth (after 22 weeks of amenorrhea) during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: Yes Indications: Inflammatory Bowel disease (IBD) 2.17 [0.70;6.66]
excluded (control group) 		35/3,554   15/3,525 50 3,554
ref
S13454
R51834		 Meyer b (Controls unexposed, sick), 2021 Stillbirth (after 22 weeks of amenorrhea) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Indications: Inflammatory Bowel disease (IBD) 2.24 [1.28;3.92] 35/3,554   105/19,811 140 3,554
ref
S6698
R52665		 Alami, 2017 In utero fetal death, > 22 GW at least 1st trimester prospective cohort unexposed, sick Adjustment: No Indications: Any or not specified 4.07 [0.45;36.89] C 4/127   1/126 5 127
ref
S10792
R52289		 Casanova, 2013 Fetal Loss 3 months (or more) before pregnancy or during pregnancy excluded retrospective cohort exposed to other treatment, sick Adjustment: No Indications: Inflammatory Bowel disease (IBD) 0.85 [0.08;9.43] C
excluded (exposition period) 		1/187   2/318 3 187
ref
S8427
R44741		 Goldstein, 2007 Stillbirth (NOS) at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Indications: Any or not specified 3.95 [0.40;38.30] 3/177   1/230 4 177
ref
S13766
R53604		 Dejaco, 2005 Stillbirth during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No Indications: Inflammatory Bowel disease (IBD) 1.06 [0.02;55.09] C 0/33   0/35 0 33
ref
Total 4 studies 2.36 [1.40;3.97] 149 3,891
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 b (Controls unexposed, sick), 2021Meyer b, 2021 1 2.24[1.28; 3.92]1403,55487%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Alami, 2017Alami, 2017 4.07[0.45; 36.89]51276%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: unclearROB reporting: moderate Goldstein, 2007Goldstein, 2007 3.95[0.40; 38.30]41775%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Dejaco, 2005Dejaco, 2005 1.06[0.02; 55.09]0332%ROB confusion: seriousROB selection: unclearROB classification: unclearROB missing: unclearROB mesure: unclearROB reporting: moderate Total (4 studies) I2 = 0% 2.36[1.40; 3.97]1493,8910.510.01.0ROB: 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 2.36[1.40; 3.97]1493,8910%NAMeyer b (Controls unexposed, sick), 2021 Alami, 2017 Goldstein, 2007 Dejaco, 2005 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 3.95[0.40; 38.65]4177 -NAGoldstein, 2007 1 unexposed, sickunexposed, sick 2.29[1.34; 3.92]1453,7140%NAMeyer b (Controls unexposed, sick), 2021 Alami, 2017 Dejaco, 2005 3 Tags Adjustment   - No  - No 3.33[0.77; 14.52]93370%NAAlami, 2017 Goldstein, 2007 Dejaco, 2005 3   - Yes  - Yes 2.24[1.28; 3.92]1403,554 -NAMeyer b (Controls unexposed, sick), 2021 1 Indications   - Any or not specified  - Any or not specified 4.01[0.82; 19.57]93040%NAAlami, 2017 Goldstein, 2007 2   - Inflammatory Bowel disease (IBD)  - Inflammatory Bowel disease (IBD) 2.21[1.27; 3.84]1403,5870%NAMeyer b (Controls unexposed, sick), 2021 Dejaco, 2005 2 All studiesAll studies 2.36[1.40; 3.97]1493,8910%NAMeyer b (Controls unexposed, sick), 2021 Alami, 2017 Goldstein, 2007 Dejaco, 2005 40.510.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.75.62.4180.000Meyer b (Controls unexposed, sick), 2021Alami, 2017Goldstein, 2007Dejaco, 2005

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 13576

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 3.95[0.40; 38.65]4177 -NAGoldstein, 2007 1 unexposed, sick controlsunexposed, sick controls 2.29[1.34; 3.92]1453,7140%NAMeyer b (Controls unexposed, sick), 2021 Alami, 2017 Dejaco, 2005 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 2.17[0.70; 6.69]503,554 -NAMeyer b (Controls exposed to Anti-TNF), 2021 10.510.01.0