scholarly journals Tumor necrosis factor therapy and the risk of serious infection and malignancy in patients with early rheumatoid arthritis: A meta-analysis of randomized controlled trials

2011 ◽  
Vol 63 (6) ◽  
pp. 1479-1485 ◽  
Author(s):  
Andrew E. Thompson ◽  
Scott W. Rieder ◽  
Janet E. Pope
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Randomized Controlled Trials ◽  
Tumor Necrosis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Serious Infection ◽  
Factor Therapy ◽  
Necrosis Factor

scholarly journals Different Original and Biosimilar TNF Inhibitors Similarly Reduce Joint Destruction in Rheumatoid Arthritis—A Network Meta-Analysis of 36 Randomized Controlled Trials

2019 ◽  
Vol 20 (18) ◽  
pp. 4350 ◽  
Author(s):  
Niels Graudal ◽  
Benjamin Skov Kaas-Hansen ◽  
Louise Guski ◽  
Thorbjørn Hubeck-Graudal ◽  
Nicky J. Welton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Joint Destruction ◽  
Inhibitory Effect ◽  
Placebo Control ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
High Doses ◽  
Necrosis Factor

The effect of five approved tumour necrosis factor inhibitors (TNFi: infliximab, etanercept, adalimumab, certolizumab, and golimumab) on joint destruction in rheumatoid arthritis (RA) have been compared versus methotrexate (MTX) in randomized controlled trials (RCTs) but have not been compared directly to each other or to an otherwise untreated placebo control. The present analysis compares effects of standard doses, high doses, and low doses of TNFis on radiographic joint destruction in RA and relate these effects to MTX and placebo by means of a Bayesian network meta-analysis. We identified 31 RCTs of the effect of TNFis on joint destruction and 5 RCTs with controls, which indirectly could link otherwise untreated placebo controls to the TNFi treatments in the network. The previously untested comparison with placebo was performed to estimate not only the effect relative to another drug, but also the absolute attainable effect. Compared to placebo there was a highly significant inhibitory effect on joint destruction of infliximab, etanercept, adalimumab, certolizumab, and golimumab, which was about 0.9% per year as monotherapy and about 1.2% per year when combined with MTX. Although significantly better than MTX and placebo, golimumab seemed inferior to the remaining TNFis. There was no difference between original reference drugs (Remicade, Enbrel) and the almost identical copy drugs (biosimilars).

The Risk of Tuberculosis in Patients with Rheumatoid Arthritis Treated with Tumor Necrosis Factor-α Antagonist: A Metaanalysis of Both Randomized Controlled Trials and Registry/Cohort Studies

2015 ◽  
Vol 42 (12) ◽  
pp. 2229-2237 ◽  
Author(s):  
Jing-Wen Ai ◽  
Shu Zhang ◽  
Qiao-Ling Ruan ◽  
Yi-Qi Yu ◽  
Bing-Yan Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Cohort Studies ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Tnf Α ◽  
Factor Α ◽  
Necrosis Factor

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.

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