Meta analysis of infection risks of anti-TNF-αtreatment in rheumatoid arthritis
10.3969/j.issn.1672-7347.2013.07.013
- VernacularTitle:抗肿瘤坏死因子-α治疗类风湿关节炎致感染风险的Meta分析
- Author:
Xi XIE
;
Jinwei CHEN
;
Youming PENG
;
Jiesheng GAO
;
Jing TIAN
;
Guanghui LING
;
Jinfeng DU
;
Ni MAO
;
Peijun WU
;
Fen LI
- Publication Type:Journal Article
- Keywords:
anti-tumor necrosis factor-α;
biological agent;
rheumatoid arthritis;
infection;
Meta analysis
- From:
Journal of Central South University(Medical Sciences)
2013;38(7):722-736
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically evaluate the risks of anti-TNF-αtreatment-associated infection, severe infection and tuberculosis in rheumatoid arthritis (RA) patients, and to reduce the infection incidences associated with anti-TNF-αtherapy. Methods:We used Meta analysis to systematically review randomized controlled trials on anti-TNF-αtreatment associated risks of infecion, severe infection and tuberculosis in AR patients.Results:Although no statistically significant differences were detected in TB risk between anit-TNF-αtreatment and the control group (0.5%vs 0.07%;P=0.27, OR=1.85, 95%CI:0.62-5.52), there still existed a clinically obvious elevation of TB risk in monoclonal anti-TNF-αtreatment, which was illustrated by the results that no TB case was reported in the etanercept group, but 11 TBs in 2050 infliximab-treated cases, and 3 TBs in 722 adalimumab-treated cases. The total infection and severe infection risks were also signiifcantly higher in patients receiving anti-TNF-αtreatment (P<0.05). Subanalysis revealed that etanercept showed no signiifcantly higher infection or severe infection risk than control group (P>0.05), while both kinds of monoclonal antibodies of TNF-αblockers showed a signiifcantly elevated infection or severe infection risks (P<0.05). High doses of anti-TNF-αtreatment were associated with statistically increased risks of severe infection (6.0%vs 2.8%, P=0.04, OR=1.68, 95%CI:1.02-2.78). Conclusion:The TB risk of anti-TNF-αtreatment deserves close attention, especially in places with high rate of BCG vaccination and MTb infection. Monoclonal anti-TNF-αtreatment brings higher risks of infection and severe infection than soluble TNF-αreceptor.
