Observational studies of infections in rheumatoid arthritis: a metaanalysis of tumor necrosis factor antagonists.
OBJECTIVE
Published metaanalyses of tumor necrosis factor (TNF) antagonists and infection have focused on randomized controlled trials, which tend to have short duration, relatively small size, and stringent inclusion/exclusion criteria that may limit enrollment to patients at low risk of infection. We performed a systematic review and synthesis of observational studies of TNF antagonists and infection risk.


METHODS
We conducted a systematic literature search of studies estimating overall risk of serious infection after anti-TNF exposure in rheumatoid arthritis (RA). We estimated a pooled relative risk (RR) for the relevant observational studies, using a random-effects model.


RESULTS
Five cohort studies and 2 nested case-control studies were included in the metaanalysis. Anti-TNF therapy appeared to significantly increase risk of serious infection (pooled adjusted RR 1.37, 95% CI 1.18, 1.60).


CONCLUSIONS
Our metaanalysis of observational data demonstrated an increased risk of serious infection in subjects with RA receiving anti-TNF therapy, versus those not receiving these agents.
Bernatsky
Sasha
S
Division of Clinical Epidemiology, Department of Medicine, and the Research Institute, McGill University Health Centre, Montreal, Quebec, Canada. sasha.bernatsky@mail.mcgill.ca
Habel
Youssef
Y
Rahme
Elham
E
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D015331:Cohort Studies; D006801:Humans; D007239:Infections / Q000139:chemically induced*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha