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KMID : 0941820180280040333
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Korean Journal of Clinical Pharmacy
2018 Volume.28 No. 4 p.333 ~ p.341
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Effects of Tumor Necrosis Factor-alpha Inhibitors on the Incidence of Tuberculosis
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Park Hyun-Jin
Choi Bo-Yoon
Sohn Min-Ji
Han Na-Young
Kim In-Wha
Oh Jung-Mi
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Abstract
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Tumor necrosis factor-alpha (TNF-alpha) inhibitors are used as a treatment in various immune-mediated inflammatorydiseases (IMIDs). Tuberculosis (TB) risk is reported in several meta-analyses in patients treated with TNF-alpha inhibitors. Thepurpose of this study is to collect, review, and evaluate the TB risk in TNF-alpha inhibitors according to IMIDs indications andbetween soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors. Methods: A systematic literaturesearch on systematic reviews and meta-analyses was performed in PubMed, MEDLINE, Cochrane library, and EMBASE. Weidentified meta-analyses that evaluated TB infection risk of TNF-alpha inhibitors in IMIDs patients. Results: Thirteen meta-analysesincluding 41 study results were included in this umbrella review. IMIDs patients treated with TNF-alpha inhibitors had an increasedrisk of TB than control group (placebo with or without standard therapy patients) (relative risk ratio (RR) 2.057, 95% confidenceinterval (CI) 1.697 to 2.495). Among them, RA patients with TNF-alpha inhibitors had a higher risk of TB than control group (RR1.847, 95% CI 1.385 to 2.464), and non-RA patients with TNF-alpha inhibitors had an increased risk of TB (RR 2.236, 95% CI 1.284to 3.894). In subgroup analysis on TB risk between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alphainhibitors in RA patients, the analysis indicated that monoclonal-antibody TNF-alpha inhibitors had higher risk of TB than solublereceptorTNF-alpha inhibitor (RR 2.880, 95% CI 1.730 to 4.792). Conclusion: This umbrella review confirms that the risk of TB issignificantly increased in TNF-alpha inhibitor treated patients compared to control group.
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KEYWORD
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Tumor necrosis factor-alpha inhibitor, tuberculosis, immune-mediated inflammatory disease, rheumatoid arthritis, umbrella review
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