Jing-Wen Ai1, Shu Zhang1, Qiao-Ling Ruan1, Yi-Qi Yu1, Bing-Yan Zhang1, Qi-Hui Liu1, Wen-Hong Zhang2. 1. From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University. 2. From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University. zhangwenhong@fudan.edu.cn.
Abstract
OBJECTIVE: Tumor necrosis factor-α (TNF-α) antagonists have significantly improved treatment results in rheumatoid arthritis (RA), but have also increased the risk of tuberculosis (TB). Etanercept (ETN), adalimumab (ADA), infliximab (IFX), golimumab, and certolizumab pegol are the 5 drugs currently available on the market. This article aimed to evaluate the risk of TB infection from these 5 drugs for patients with RA. METHODS: We searched PubMed, EMBASE, COCHRANE library, OVID, and EBSCO for randomized controlled trials (RCT) of TNF-α antagonist versus control and registry/longitudinal cohort studies of 1 TNF-α antagonist versus another. The Mantel-Haenszel test was adopted to analyze risk ratio (RR) in this metaanalysis. RESULTS: Fifty RCT and 13 non-RCT were included in this study. No significant difference in TB risk was found in the RCT because of the short observational periods. In the non-RCT, TNF-α antagonist was associated with a higher TB risk in patients with RA (RR 4.03, 95% CI 2.36-6.88), and the TB incidence rates of IFX and ADA were 2.78 and 3.88 times, respectively, higher than that of ETN. Further, preventive treatment for latent TB infection (LTBI) was shown to reduce the TB risk by 65% (RR 0.35, 95% CI 0.15-0.82). CONCLUSION: This study demonstrated a significant increase in TB risk in patients with RA treated with TNF-α antagonists; among them, ETN is least likely to cause active TB. The study also proposes the necessity of LTBI prophylaxis in patients with RA.
OBJECTIVE: Tumor necrosis factor-α (TNF-α) antagonists have significantly improved treatment results in rheumatoid arthritis (RA), but have also increased the risk of tuberculosis (TB). Etanercept (ETN), adalimumab (ADA), infliximab (IFX), golimumab, and certolizumab pegol are the 5 drugs currently available on the market. This article aimed to evaluate the risk of TB infection from these 5 drugs for patients with RA. METHODS: We searched PubMed, EMBASE, COCHRANE library, OVID, and EBSCO for randomized controlled trials (RCT) of TNF-α antagonist versus control and registry/longitudinal cohort studies of 1 TNF-α antagonist versus another. The Mantel-Haenszel test was adopted to analyze risk ratio (RR) in this metaanalysis. RESULTS: Fifty RCT and 13 non-RCT were included in this study. No significant difference in TB risk was found in the RCT because of the short observational periods. In the non-RCT, TNF-α antagonist was associated with a higher TB risk in patients with RA (RR 4.03, 95% CI 2.36-6.88), and the TB incidence rates of IFX and ADA were 2.78 and 3.88 times, respectively, higher than that of ETN. Further, preventive treatment for latent TB infection (LTBI) was shown to reduce the TB risk by 65% (RR 0.35, 95% CI 0.15-0.82). CONCLUSION: This study demonstrated a significant increase in TB risk in patients with RA treated with TNF-α antagonists; among them, ETN is least likely to cause active TB. The study also proposes the necessity of LTBI prophylaxis in patients with RA.
Authors: Muhammad Farooq Rai; Hua Pan; Huimin Yan; Linda J Sandell; Christine T N Pham; Samuel A Wickline Journal: Transl Res Date: 2019-07-10 Impact factor: 7.012
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Authors: Richard M Beteck; Ronnett Seldon; Audrey Jordaan; Digby F Warner; Heinrich C Hoppe; Dustin Laming; Lesetja J Legoabe; Setshaba D Khanye Journal: Medchemcomm Date: 2019-01-11 Impact factor: 3.597