title: The safety of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis.
abstract: BACKGROUND
  Tumor necrosis factor inhibitors (TNFi) were the first biologic therapy authorized for rheumatoid arthritis (RA) treatment and are currently the most used biological drugs in these patients. Although clinical efficacy is proven, adverse events associated with these agents have been described, and further knowledge is essential to facilitate detection at very early stages.
  
  
  METHODS
  We reviewed the safety profile of TNFi, including both articles and congress communications published on this topic, such as clinical trials, meta-analyses, observational studies, data from registries, and spontaneous clinical reports. We classified studies according to the most common and relevant adverse events associated with TNFi.
  
  
  CONCLUSIONS
  There is a broad spectrum of possible adverse events associated with TNFi treatment, ranging from mild to serious, and with diverse clinical manifestations. However, most adverse events may be minimized by appropriate screening before starting treatment and with ongoing surveillance to ensure an early diagnosis. In conclusion, TNFi have a reasonable safety profile, and, globally, the benefits far outweigh the possible risk of adverse events, especially compared with the risk of the untreated underlying inflammatory condition.
authors.affiliation: a Arthritis Unit, Rheumatology Department , Hospital Clínic of Barcelona , Barcelona , Spain.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: a Arthritis Unit, Rheumatology Department , Hospital Clínic of Barcelona , Barcelona , Spain.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
authors.affiliation: a Arthritis Unit, Rheumatology Department , Hospital Clínic of Barcelona , Barcelona , Spain.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Biological therapy; TNF antagonists; adverse events; drug risk