Comparison of the risk of infections in different anti-TNF agents: a meta-analysis.
BACKGROUND
Anti-tumor necrosis factor α (anti-TNF-α) treatments are widely used in patients with rheumatoid arthritis (RA); however, the increased risk of infections is one of the most important side effects of anti-TNF-α agents. This study evaluated the differences between monoclonal antibodies and the soluble receptor for infections in patients with RA by direct comparison of observation studies.


METHODS
A systemic literature search was conducted in March 2014 and an up-to-date search was conducted in August 2014. All studies reporting infections in RA patients treated with the soluble receptor (ETA [etanercept]) and at least one of monoclonal antibodies (INF [infliximab], ADA [adalimumab]) were included.


RESULTS
Twelve articles were finally included. The meta-analysis revealed that compared with monoclonal antibodies, the soluble receptor had a lower incidence rate of serious infections (relative risk [RR] = 0.63 [0.40-0.97] P = 0.04), but we have to notice that the heterogeneity was high (I2= 85%) and publication bias might exist. As to tuberculosis, the pooled analysis revealed that the soluble receptor had a lower risk (RR = 0.19 [0.06-0.56] P = 0.003) and its heterogeneity was low (I2= 0%) while no publication bias was observed. For general infections, ETA had a lower risk compared with mono-antibodies and its heterogeneity was high (RR = 0.66 [0.49-0.89] P < 0.00001 I2= 79%).


CONCLUSIONS
Compared with mono-antibodies, the soluble receptor has a lower risk for tuberculosis and general infections. But as to serious infections, the answer is uncertain due to its high heterogeneity and possibility of publication bias. More well-designed long-term prospective studies would be important to strengthen these findings.
Division of Joint Surgery, Orthopedic Department, The Meizhou People's Hospital, Meizhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Hongxing
H
Liao
Division of Joint Surgery, Orthopedic Department, The Meizhou People's Hospital, Meizhou, Guangdong, China.
Zhixiong
Z
Zhong
Division of Joint Surgery, Orthopedic Department, The Meizhou People's Hospital, Meizhou, Guangdong, China.
Zhanliang
Z
Liu
Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Xuenong
X
Zou
D000068879:Adalimumab / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects*; D016009:Chi-Square Distribution; D000068800:Etanercept / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D000069285:Infliximab / Q000009:adverse effects; D008875:Middle Aged; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000453:epidemiology / Q000276:immunology; D018570:Risk Assessment; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
anti-TNF agents; mono-antibodies; rheumatoid arthritis; soluble receptor