Risk of Adverse Events After Anti-TNF Treatment for Inflammatory Rheumatological Disease. A Meta-Analysis

Abstract

Background: Adalimumab, golimumab, infliximab, certolizumab, and etanercept are five anti-tumor necrosis factor (anti-TNF) medicines that have been approved for use in rheumatology. Apart from their well-established therapeutic usefulness, -it is unclear to what extent -they are linked to an increased risk of various side effects. The present meta-analysis was carried out to assess the risk of infection and other side effects after anti-TNF- α for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.Methods: We searched PubMed, Cinahl (via Ebsco), Scopus, and Web of Sciences databases for trials comparing anti-TNF medications to placebo or no therapy in adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis from August 2006 to August 2020. A total of 23 articles were used for meta-analysis. The Cochrane Collaboration’s risk of bias tool was used to assess the methodological quality of the included studies. In addition, a random-effects model was used to calculate the pooled odds ratio, and Forest plots were constructed to determine the risk of infections and cancer following the use of anti-TNF treatment.Results: Treatment with anti-TNFα agents resulted in an increase in the risk of serious infections (OR: 1.72, 95% CI: 1.56–1.90, p < 0.00001) and an increase in cancer risk (OR: 1.36, 95% CI: 1.20–1.53, p < 0.00001) whereas the risk of developing tuberculosis was not significantly different with anti-TNFα agents versus those without treatment with anti-TNFα agents (OR: 2.55, 95% CI: 0.40–16.23, p = 0.32) although the number of studies is limited to make a definitive conclusion. The risk of bias of the included studies was unclear to high across most domains, and there was evidence of publication bias for most outcomes.Conclusion: The present meta-analysis suggests an increased risk of infectious adverse events, including overall adverse events and cancer following anti-TNFα treatment, whereas the risk of tuberculosis was not significantly different. Although anti-TNF agents have shown promise to treat inflammatory conditions, their use should be balanced by the risk-benefit ratio as suggested by the meta-analysis.

Immunosuppressant Therapies in COVID-19: Is the TNF Axis an Alternative?

“…Although the current TNF inhibitors are highly efficient, it has been well documented that total TNF inhibition may lead to severe side effects such as tuberculosis reactivation [ 127 , 128 ]. An advantage is that TNFR1 and TNFR2 mediate different cellular events, the reason why the option of selectively blocking one of them may result in fewer adverse effects [ 129 , 130 ].…”

Ebosin Attenuates the Inflammatory Responses Induced by TNF-α through Inhibiting NF-κB and MAPK Pathways in Rat Fibroblast-Like Synoviocytes

“…Although anti-TNF agents have been shown to improve the outcome of the management of RA, a proportion of patients does not respond well to anti-TNF therapy and has increased the risk of adverse events such as infections [20][21][22][23][24]. Unlike antibody-based agents, ebosin is the first EPS produced by the Streptomyces genus with a novel structure [19].…”

Adalimumab-Induced Erythema Multiforme in a Patient With Rheumatoid Arthritis: A Case Report

“…Five different anti-TNF-α drugs have entered clinical use: infliximab (IFX), adalimumab (ADA), etanercept (ETC), golimumab (GLM), and certolizumab pegol (CZP) have been used for the treatment of RA [2]. Though different studies have successfully demonstrated the efficacy and safety of anti-TNF-α, there is still debate regarding the potential untoward effects of these biologicals [3]. Serious adverse reactions involving the skin and oral mucosa have been reported with the use of the fully-humanized monoclonal antibody adalimumab.…”