Effects of Tumor Necrosis Factor-alpha Inhibitors on the Incidence of Tuberculosis.
10.24304/kjcp.2018.28.4.333
- Author:
Hyun Jin PARK
1
;
Bo Yoon CHOI
;
Minji SOHN
;
Na Young HAN
;
In Wha KIM
;
Jung Mi OH
Author Information
1. College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea. jmoh@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Tumor necrosis factor-alpha inhibitor;
tuberculosis;
immune-mediated inflammatory disease;
rheumatoid arthritis;
umbrella review
- MeSH:
Arthritis, Rheumatoid;
Humans;
Incidence*;
Odds Ratio;
Tuberculosis*;
Tumor Necrosis Factor-alpha*
- From:Korean Journal of Clinical Pharmacy
2018;28(4):333-341
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Tumor necrosis factor-alpha (TNF-alpha) inhibitors are used as a treatment in various immune-mediated inflammatory diseases (IMIDs). Tuberculosis (TB) risk is reported in several meta-analyses in patients treated with TNF-alpha inhibitors. The purpose of this study is to collect, review, and evaluate the TB risk in TNF-alpha inhibitors according to IMIDs indications and between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors. METHODS: A systematic literature search on systematic reviews and meta-analyses was performed in PubMed, MEDLINE, Cochrane library, and EMBASE. We identified meta-analyses that evaluated TB infection risk of TNF-alpha inhibitors in IMIDs patients. RESULTS: Thirteen meta-analyses including 41 study results were included in this umbrella review. IMIDs patients treated with TNF-alpha inhibitors had an increased risk of TB than control group (placebo with or without standard therapy patients) (relative risk ratio (RR) 2.057, 95% confidence interval (CI) 1.697 to 2.495). Among them, RA patients with TNF-alpha inhibitors had a higher risk of TB than control group (RR 1.847, 95% CI 1.385 to 2.464), and non-RA patients with TNF-alpha inhibitors had an increased risk of TB (RR 2.236, 95% CI 1.284 to 3.894). In subgroup analysis on TB risk between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors in RA patients, the analysis indicated that monoclonal-antibody TNF-alpha inhibitors had higher risk of TB than solublereceptor TNF-alpha inhibitor (RR 2.880, 95% CI 1.730 to 4.792). CONCLUSION: This umbrella review confirms that the risk of TB is significantly increased in TNF-alpha inhibitor treated patients compared to control group.
