Anti-TNF Antibody Therapy in Rheumatoid Arthritis and the Risk of Serious Infections and Malignancies

Abstract

There is evidence of an increased risk of serious infections and a dose-dependent increased risk of malignancies in patients with rheumatoid arthritis treated with anti-TNF antibody therapy. The formal meta-analysis with pooled sparse adverse events data from randomized controlled trials serves as a tool to assess harmful drug effects.

Risk of incident or recurrent malignancies among patients with rheumatoid arthritis exposed to biologic therapy in the German biologics register RABBIT

“…However, our results for the first year are in contrast to the meta-analyses reported by Bongartz et al [3,4]. In the first year of treatment patients receiving biologics had a lower risk for developing an incident malignancy than those receiving conventional DMARDs.…”

“Serious skin & soft tissue infections in rheumatoid arthritis patients taking anti-tumor necrosis factor alpha drugs: a nested case–control study”

“…In relation to existing research, our findings differ from earlier studies that reported an association between anti-TNF drug treatment and an increase in all serious infections in RA patients [19,20]. Conversely, recent studies reported similar results to ours, and found no association between anti-TNF therapy and increased risk of infection in RA patients [22].…”

Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: retrospective cohort study

“…However, the large adverse effects we observed add to concerns that use of these agents may substantially increase overall and cancer mortality. A previous meta-analysis of randomised trial data, which showed increased risk of cancer with TNF inhibitor therapy with a dose-response pattern,14 is consistent with our findings. However, our findings are inconsistent with those of four large observational studies of patients with rheumatoid arthritis over substantially longer periods3 15 16 17 and one study of patients with Crohn’s disease,18 each of which found no increased overall cancer risk, with risk ratios close to 1.0.…”

“…However, our findings are inconsistent with those of four large observational studies of patients with rheumatoid arthritis over substantially longer periods3 15 16 17 and one study of patients with Crohn’s disease,18 each of which found no increased overall cancer risk, with risk ratios close to 1.0. It has previously been proposed that TNF inhibitors may accelerate the clinical course of pre-existing but subclinical cancers, but may not initiate cancer 14. If so, an initially increased risk of clinically manifest cancer should be diluted with a longer duration of follow-up, which would be consistent with the available publications and our results.…”