The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: A systematic review and meta-analysis of randomized controlled trials - 10/08/11
Reprint requests: Joel M. Gelfand, MD, MSCE, Department of Biostatistics and Epidemiology, University of Pennsylvania, One Convention Ave, 1471 Penn Tower, Philadelphia, PA 19104.Abstract |
Background |
There is a need to better understand the safety of tumor necrosis factor (TNF) inhibitors in patients with psoriatic disease in whom TNF inhibitors are frequently used as monotherapy.
Objective |
We sought to examine the risks of infection and malignancy with the use of TNF antagonists in adult patients with psoriatic disease.
Methods |
We conducted a systematic search for trials of TNF antagonists for adults with plaque psoriasis and psoriatic arthritis. We included randomized, placebo-controlled trials of etanercept, infliximab, adalimumab, golimumab, and certolizumab for the treatment of plaque psoriasis and psoriatic arthritis. Twenty of 820 identified studies with a total of 6810 patients were included. Results were calculated using fixed effects models and reported as pooled odds ratios.
Results |
Odds ratios for overall infection and serious infection over a mean of 17.8 weeks were 1.18 (95% confidence interval [CI] 1.05-1.33) and 0.70 (95% CI 0.40-1.21), respectively. When adjusting for patient-years, the incidence rate ratio for overall infection was 1.01 (95% CI 0.92-1.11). The odds ratio for malignancy was 1.48 (95% CI 0.71-3.09) and 1.26 (95% CI 0.39-4.15) when nonmelanoma skin cancer was excluded.
Limitations |
Short duration of follow-up and rarity of malignancies and serious infections are limitations.
Conclusions |
There is a small increased risk of overall infection with the short-term use of TNF antagonists for psoriasis that may be attributable to differences in follow-up time between treatment and placebo groups. There was no evidence of an increased risk of serious infection and a statistically significant increased risk in cancer was not observed with short-term use of TNF inhibitors.
Le texte complet de cet article est disponible en PDF.Key words : biologics, cancer, infection, malignancy, meta-analysis, psoriasis, psoriatic arthritis, safety, tumor necrosis factor-alfa
Abbreviations used : CI, DMARD, IRR, NMSC, OR, PsA, PsO, PY, RA, RCT, SAE, TNF
Plan
| Supported in part by grants K23AR051125 and RC1 ARO58204 from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (Dr Gelfand), and a National Research Service Award from the National Institute of Health (Dr Dommasch). |
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| Disclosure: Dr Gelfand receives grant support and is an investigator for Amgen, Abbott, Novartis, and Pfizer. He is a consultant for Pfizer, Genentech, Celgene, Amgen, Centocor, Novartis, and Abbott. Dr Dommasch, Dr Abuabara, Mr Shin, Dr Nguyen, and Dr Troxel have no conflicts of interest to declare. |
Vol 64 - N° 6
P. 1035-1050 - juin 2011 Retour au numéro
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