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- Title
Adverse Events and Nocebo Effects in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
- Authors
Ma, Christopher; Panaccione, Nicola R; Nguyen, Tran M; Guizzetti, Leonardo; Parker, Claire E; Hussein, Isra M; Casteele, Niels Vande; Khanna, Reena; Dulai, Parambir S; Singh, Siddharth; Feagan, Brian G; Jairath, Vipul
- Abstract
Background and Aims Nocebo effects, adverse outcomes occurring in patients receiving inert therapy, contribute to adverse event [AE] reporting in randomized controlled trials [RCTs]. High placebo AE rates may result in inaccurate estimation of treatment-related AEs. We estimate the pooled rate of AEs in patients randomized to placebo compared to active therapy in inflammatory bowel disease [IBD] RCTs. Methods MEDLINE, EMBASE and CENTRAL were searched to March 1, 2017 for RCTs of conventional medical therapies for Crohn's disease [CD] or ulcerative colitis [UC]. Rates of AEs, serious AEs [SAEs], AE-related trial withdrawal, infections and worsening IBD were pooled using a random-effects model. Results We included 124 CD [ n = 26 042] and 71 UC RCTs [ n = 16 798]. The pooled placebo AE rate was 70.6% (95% confidence interval [CI]: 65.3%, 75.4%) and 54.5% [47.8%, 61.1%] in CD and UC RCTs, respectively. There was no significant risk difference [RD] in AE, SAE or AE-related withdrawal rates between CD patients receiving placebo or active drug. A 1.6% [95% CI: 0.1%, 3.1%] increase in AE rates was observed among UC patients randomized to active therapy. Patients receiving active therapy had a higher risk of infection (RD 1.0% [95% CI: 0.4%, 1.7%] for CD, 2.9% [95% CI: 1.4%, 4.4%] for UC) although a lower risk of worsening CD (RD −3.2% [95% CI: −4.8%, −1.5%]) or UC (RD –3.7% [95% CI: –5.7%, –1.8%]). Conclusions AEs are commonly reported by patients randomized to either placebo or active treatment in IBD RCTs. Clinically relevant differences in AE, SAE and AE-related withdrawal were not observed.
- Publication
Journal of Crohn's & Colitis, 2019, Vol 13, Issue 9, p1201
- ISSN
1873-9946
- Publication type
Article
- DOI
10.1093/ecco-jcc/jjz087