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http://dx.doi.org/10.24304/kjcp.2018.28.4.333

Effects of Tumor Necrosis Factor-alpha Inhibitors on the Incidence of Tuberculosis  

Park, Hyun Jin (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Choi, Bo Yoon (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Sohn, Minji (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Han, Na Young (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Kim, In-Wha (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Oh, Jung Mi (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Publication Information
Korean Journal of Clinical Pharmacy / v.28, no.4, 2018 , pp. 333-341 More about this Journal
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 soluble-receptor 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.
Keywords
Tumor necrosis factor-alpha inhibitor; tuberculosis; immune-mediated inflammatory disease; rheumatoid arthritis; umbrella review;
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