PT  - JOURNAL ARTICLE
AU  - Jing-Wen Ai
AU  - Shu Zhang
AU  - Qiao-Ling Ruan
AU  - Yi-Qi Yu
AU  - Bing-Yan Zhang
AU  - Qi-Hui Liu
AU  - Wen-Hong Zhang
TI  - The Risk of Tuberculosis in Patients with Rheumatoid Arthritis Treated with Tumor Necrosis Factor-α Antagonist: A Metaanalysis of Both Randomized Controlled Trials and Registry/Cohort Studies
AID  - 10.3899/jrheum.150057
DP  - 2015 Oct 15
TA  - The Journal of Rheumatology
PG  - jrheum.150057
4099  - http://www.jrheum.org/content/early/2015/10/07/jrheum.150057.short
4100  - http://www.jrheum.org/content/early/2015/10/07/jrheum.150057.full
AB  - Objective Tumor necrosis factor-α (TNF-α) antagonists have significantly improved treatment results in rheumatoid arthritis (RA), but have also increased the risk of tuberculosis (TB). Etanercept (ETN), adalimumab (ADA), infliximab (IFX), golimumab, and certolizumab pegol are the 5 drugs currently available on the market. This article aimed to evaluate the risk of TB infection from these 5 drugs for patients with RA. Methods We searched PubMed, EMBASE, COCHRANE library, OVID, and EBSCO for randomized controlled trials (RCT) of TNF-α antagonist versus control and registry/longitudinal cohort studies of 1 TNF-α antagonist versus another. The Mantel-Haenszel test was adopted to analyze risk ratio (RR) in this metaanalysis. Results Fifty RCT and 13 non-RCT were included in this study. No significant difference in TB risk was found in the RCT because of the short observational periods. In the non-RCT, TNF-α antagonist was associated with a higher TB risk in patients with RA (RR 4.03, 95% CI 2.36-6.88), and the TB incidence rates of IFX and ADA were 2.78 and 3.88 times, respectively, higher than that of ETN. Further, preventive treatment for latent TB infection (LTBI) was shown to reduce the TB risk by 65% (RR 0.35, 95% CI 0.15–0.82). Conclusion This study demonstrated a significant increase in TB risk in patients with RA treated with TNF-α antagonists; among them, ETN is least likely to cause active TB. The study also proposes the necessity of LTBI prophylaxis in patients with RA.