Efficacy and tolerance of injectable biologics and antibiotics used out of hospital: systematic review and meta-analysis

Introduction: Out-of-hospital self-care in patients receiving injectable biologically derived medicines (biologics) is reported to significantly improve patients’ quality of life and reduce hospitalisations, but unexpected complications produce some negative outcomes in health and patient experience. Aim: This study aimed to conduct systematic reviews and meta-analyses of published studies to compare health outcomes and therapy complications between long-term injectable antibiotic and biologic therapies compared to placebo or conventional treatment, in and out of the hospital settings for patients diagnosed with inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), psoriasis and infections. Methods and design: To achieve the study aim, five systematic review and meta-analyses were carried out to compare outcomes and complications between long-term injectable antibiotic and biologic therapies to a control therapy. The context was based on ‘out of the hospital’ settings for patients diagnosed with IBD, RA, psoriasis and infections. Results: The first review investigated injectable biologics in treating IBD. The test for overall effect demonstrated biologics were effective compared to control (p< 0.001) and did not cause statistically significant death (p = 0.91) or mild side effects (p = 0.29) but produced more significant severe side effects (p <0.001). The second review focused on injectable biologics in treating rheumatoid arthritis. Biologics were effective compared to control (p < 0.0001) and did not cause statistically significant death (p = 0.24), severe side effects (p = 0.98) or mild side effects (p = 0.48) compared to the control group. The third review was on injectable biologics in psoriasis. The results demonstrated that biologics, while were effective compared to control (p = 0.01) and caused severe side effects (p = 0.02) but mild-moderate side effects (p = 0.17) were not statistically different in both groups. The fourth review looked at patient preference for self-administering subcutaneous injections at home (intervention) vs. intravenous injections in a hospital inpatient or outpatient setting. There was a statistically significant difference between homecare (intervention) and hospital (control) group (p = 0.05). The fifth review was on injectable antibiotics. The results demonstrated that the use of injectable antibiotics, at home (intervention) or in hospital (control) produced similar benefits (p = 0.30 cure and p = 0.90 treatment failure) and harm (hospital admission after and during treatment p = 0.64, p = 0.99 respectively, disease complications p = 0.77 and medications side effects p = 0.15). Conclusion: This research found no substantial disparities in patient outcomes based upon setting. Homecare is an essential option to ensure patient autonomy and wellbeing. The recent global COVID-19 pandemic further highlighted the importance of an option to continue long term disease management without hospitalisation.

Citation

Ebhabha, V. (2023) Efficacy and tolerance of injectable biologics and antibiotics used out of hospital: systematic review and meta-analysis. University of Wolverhampton. http://hdl.handle.net/2436/625291

Publisher

University of Wolverhampton

URI

http://hdl.handle.net/2436/625291

Type

Thesis or dissertation

Language

en

Description

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

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Theses and Dissertations