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Comparative Risk of Complications Following Intestinal Surgery After Infliximab, Vedolizumab, or Ustekinumab
Alexandra-Eleftheria Menni1, Georgios Tzikos1, George Petrakis2
11st Propaedeutic Department of Surgery, AHEPA University Hospital, 54636 Thessaloniki, Greece.
Pharmaceuticals (Basel, Switzerland)
|October 29, 2025
Summary
This study found Ustekinumab (USTK) to be the safest biologic for inflammatory bowel disease (IBD) patients undergoing surgery, with Vedolizumab (VDLZ) linked to higher ileus rates. Infliximab (INFL) showed no significant increase in complications.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Pharmacology and Pharmaceutical Sciences
Background:
- Biological therapies are increasingly used for inflammatory bowel diseases (IBD).
- A growing number of IBD patients receive biologics before intestinal surgery.
- Perioperative safety of commonly used biologics (Infliximab, Vedolizumab, Ustekinumab) in IBD surgery requires evaluation.
Purpose of the Study:
- To systematically review and compare the perioperative safety of Infliximab, Vedolizumab, and Ustekinumab in patients undergoing intestinal surgery for IBD.
- To assess the risk of overall surgical complications and specific adverse events associated with these biologic agents.
Main Methods:
- Systematic review of 34 articles (primarily retrospective studies) identified through Scopus, Medline, and PubMed up to January 2025.
- Inclusion of studies comparing surgical complications in patients treated with Infliximab, Vedolizumab, or Ustekinumab versus a control group.
- Meta-analysis using the Mantel-Haenszel method to aggregate relative risks and I² statistic for heterogeneity assessment.
Main Results:
- Infliximab (INFL) did not show a significant increase in overall postoperative complications (RR = 1.13).
- Vedolizumab (VDLZ) trended towards increased complications (RR = 1.26) and was linked to a higher risk of postoperative ileus compared to INFL (RR = 2.29).
- Ustekinumab (USTK) showed no significant difference in overall complications (RR = 0.55) and was associated with a lower risk of surgical site infections (SSIs) (RR = 0.35).
Conclusions:
- Ustekinumab (USTK) demonstrated the most favorable perioperative safety profile among the evaluated biologics for IBD surgery.
- Vedolizumab (VDLZ) was associated with increased rates of ileus and inflammatory complications.
- Further prospective studies are warranted to confirm these findings and guide clinical practice.
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