TNF-alpha inhibitors

Elective/induced termination of pregnancy

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.
S4995
R13080		 Drechsel, 2020 Elective termination 1st trimester prospective cohort unexposed, sick Adjustment: No 0.92 [0.24;3.59] C 3/21   13/85 16 21
ref
S4103
R8787		 Lichtenstein - infliximab, 2018 Elective abortions 3 months or more before pregnancy or1st trimester excluded prospective cohort exposed to other treatment, sick Adjustment: No 4.64 [0.22;97.92] C
excluded (exposition period) 		2/99   0/90 2 99
ref
S4098
R8756		 Carman - Etanercept (Controls unexposed, disease free), 2017 Induced abortion (therapeutic, elective, and unspecified pregnancies) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, disease free excluded Adjustment: No 0.95 [0.63;1.43] C
excluded (control group) 		30/337   157/1,685 187 337
ref
S4099
R8772		 Carman - Etanercept (Controls unexposed, sick), 2017 Induced abortion (therapeutic, elective, and unspecified pregnancies) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No 1.04 [0.70;1.55] C 30/337   246/2,861 276 337
ref
S2888
R4116		 Weber-Schoendorfer, 2015 Elective terminations of pregnancy 1st trimester prospective cohort unexposed, disease free Adjustment: Yes 1.69 [1.00;2.90] 34/495   57/1,532 91 495
ref
S2897
R4077		 Diav-Citrin (Controls exposed to other treatments), 2014 Elective terminations of pregnancy 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No 1.77 [0.41;7.67] C
excluded (control group) 		5/83   3/86 8 83
ref
S2893
R4060		 Diav-Citrin (Controls unexposed, disease free), 2014 Elective terminations of pregnancy 1st trimester prospective cohort unexposed, disease free Adjustment: No 7.22 [1.69;30.86] C 5/83   3/341 8 83
ref
S3103
R4822		 Vinet, 2013 Induced abortions during pregnancy (anytime or not specified) case control unexposed, sick Adjustment: Yes 2.07 [0.81;5.27] 7/186   105/5,781 112 186
ref
S2916
R4126		 Verstappen, 2011 Termination of pregnancy early pregnancy prospective cohort unexposed, sick Adjustment: No 2.91 [0.51;16.57] C 4/50   2/69 6 50
ref
Total 6 studies 1.65 [1.03;2.65] 509 1,172
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 Drechsel, 2020Drechsel, 2020 0.92[0.24; 3.59]16219%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Carman - Etanercept (Controls unexposed, sick), 2017Carman - Etanercept, 2017 1 1.04[0.70; 1.55]27633732%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Weber-Schoendorfer, 2015Weber-Schoendorfer, 2015 1.69[1.00; 2.90]9149527%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Diav-Citrin (Controls unexposed, disease free), 2014Diav-Citrin, 2014 2 7.22[1.69; 30.86]8839%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Vinet, 2013Vinet, 2013 2.07[0.81; 5.27]11218616%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Verstappen, 2011Verstappen, 2011 2.91[0.51; 16.57]6506%ROB confusion: NAROB selection: NAROB classification: NAROB missing: NAROB mesure: NAROB reporting: NA Total (6 studies) I2 = 46% 1.65[1.03; 2.65]5091,1720.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Controls unexposed, disease free;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.62[0.92; 2.83]39798653%NADrechsel, 2020 Carman - Etanercept (Controls unexposed, sick), 2017 Weber-Schoendorfer, 2015 Diav-Citrin (Controls unexposed, disease free), 2014 Verstappen, 2011 5 case control studiescase control studies 2.07[0.81; 5.28]112186 -NAVinet, 2013 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.97[0.74; 11.87]9957870%NAWeber-Schoendorfer, 2015 Diav-Citrin (Controls unexposed, disease free), 2014 2 unexposed, sickunexposed, sick 1.18[0.83; 1.67]4105940%NADrechsel, 2020 Carman - Etanercept (Controls unexposed, sick), 2017 Vinet, 2013 Verstappen, 2011 4 Tags Adjustment   - No  - No 1.80[0.72; 4.47]30649160%NADrechsel, 2020 Carman - Etanercept (Controls unexposed, sick), 2017 Diav-Citrin (Controls unexposed, disease free), 2014 Verstappen, 2011 4   - Yes  - Yes 1.78[1.12; 2.82]2036810%NAWeber-Schoendorfer, 2015 Vinet, 2013 2 All studiesAll studies 1.65[1.03; 2.65]5091,17246%NADrechsel, 2020 Carman - Etanercept (Controls unexposed, sick), 2017 Weber-Schoendorfer, 2015 Diav-Citrin (Controls unexposed, disease free), 2014 Vinet, 2013 Verstappen, 2011 60.220.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.42.61.0640.000Drechsel, 2020Carman - Etanercept (Controls unexposed, sick), 2017Weber-Schoendorfer, 2015Diav-Citrin (Controls unexposed, disease free), 2014Vinet, 2013Verstappen, 2011

Asymetry test p-value = 0.1514 (by Egger's regression)

slope=-0.1718 (0.3318); intercept=1.6525 (0.9334); t=1.7704; p=0.1514

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 2897, 4098

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.72[0.79; 3.76]28691577%NACarman - Etanercept (Controls unexposed, disease free), 2017 Weber-Schoendorfer, 2015 Diav-Citrin (Controls unexposed, disease free), 2014 3 unexposed, sick controlsunexposed, sick controls 1.18[0.83; 1.67]4105940%NADrechsel, 2020 Carman - Etanercept (Controls unexposed, sick), 2017 Vinet, 2013 Verstappen, 2011 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.77[0.41; 7.67]883 -NADiav-Citrin (Controls exposed to other treatments), 2014 10.510.01.0