title: All-cause Mortality Associated with TNF-α Inhibitors in Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To compare mortality data obtained from randomized controlled trials for the 5 tumor necrosis factor-α (TNF-α) inhibitors used in the treatment of rheumatoid arthritis.
  
  
  METHODS
  A systematic review of articles published up to November 2014 was performed using electronic databases. We included randomized, controlled trials, with a follow-up period of at least 24 weeks, comparing TNF-α inhibitors to placebo or disease-modifying antirheumatic drugs. The primary outcome was the occurrence of all-cause mortality.
  
  
  RESULTS
  Twenty-three studies were selected. These articles included 6525 patients in the anti-TNF-α group and 3523 in the control group. The duration of patient follow-up ranged from 24 to 104 weeks. The risk of all-cause mortality in patients receiving TNF-α inhibitors was not significantly different from those receiving the comparator (odds ratio 1.32; 95% confidence interval, 0.76-2.29). Subgroup analyses with respect to the molecule used, the dose received, the use of TNF-α inhibitors as monotherapy or combination therapy, or the quality of the trial did not modify the findings.
  
  
  CONCLUSIONS
  This meta-analysis performed on a large number of patients and including the 5 TNF-α inhibitors currently available shows no increased risk of medium-term all-cause mortality in patients with rheumatoid arthritis.
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Poiroux
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Kahan
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France. Electronic address: jerome.avouac@cch.aphp.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Meta-analysis; Mortality; Rheumatoid arthritis; TNF-α inhibitors