scholarly journals Risk of Adverse Events After Anti-TNF Treatment for Inflammatory Rheumatological Disease. A Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Ju Li ◽  
Zhongyuan Zhang ◽  
Xinhua Wu ◽  
Jie Zhou ◽  
Deqian Meng ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Side Effects ◽  
Adverse Events ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Inflammatory Conditions ◽  
Increased Risk ◽  
Rheumatological Disease

Background: Adalimumab, golimumab, infliximab, certolizumab, and etanercept are five anti-tumor necrosis factor (anti-TNF) medicines that have been approved for use in rheumatology. Apart from their well-established therapeutic usefulness, -it is unclear to what extent -they are linked to an increased risk of various side effects. The present meta-analysis was carried out to assess the risk of infection and other side effects after anti-TNF- α for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.Methods: We searched PubMed, Cinahl (via Ebsco), Scopus, and Web of Sciences databases for trials comparing anti-TNF medications to placebo or no therapy in adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis from August 2006 to August 2020. A total of 23 articles were used for meta-analysis. The Cochrane Collaboration’s risk of bias tool was used to assess the methodological quality of the included studies. In addition, a random-effects model was used to calculate the pooled odds ratio, and Forest plots were constructed to determine the risk of infections and cancer following the use of anti-TNF treatment.Results: Treatment with anti-TNFα agents resulted in an increase in the risk of serious infections (OR: 1.72, 95% CI: 1.56–1.90, p < 0.00001) and an increase in cancer risk (OR: 1.36, 95% CI: 1.20–1.53, p < 0.00001) whereas the risk of developing tuberculosis was not significantly different with anti-TNFα agents versus those without treatment with anti-TNFα agents (OR: 2.55, 95% CI: 0.40–16.23, p = 0.32) although the number of studies is limited to make a definitive conclusion. The risk of bias of the included studies was unclear to high across most domains, and there was evidence of publication bias for most outcomes.Conclusion: The present meta-analysis suggests an increased risk of infectious adverse events, including overall adverse events and cancer following anti-TNFα treatment, whereas the risk of tuberculosis was not significantly different. Although anti-TNF agents have shown promise to treat inflammatory conditions, their use should be balanced by the risk-benefit ratio as suggested by the meta-analysis.

scholarly journals Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis

2017 ◽  
Vol 76 (6) ◽  
pp. 1101-1136 ◽  
Author(s):  
Sofia Ramiro ◽  
Alexandre Sepriano ◽  
Katerina Chatzidionysiou ◽  
Jackie L Nam ◽  
Josef S Smolen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Observational Studies ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Eligibility Criteria ◽  
Increased Risk ◽  
Serious Infections ◽  
Safety Outcomes

ObjectivesTo assess the safety of synthetic (s) and biological (b) disease-modifying antirheumatic drugs (DMARDs) for the management of rheumatoid arthritis (RA) to inform the European League Against Rheumatism recommendations for the management of RA.MethodsSystematic literature review (SLR) of observational studies comparing any DMARD with another intervention for the management of patients with RA. All safety outcomes were included. A comparator group was required for the study to be included. Risk of bias was assessed with the Hayden's tool.ResultsTwenty-six observational studies addressing diverse safety outcomes of therapy with bDMARDs met eligibility criteria (15 on serious infections, 4 on malignancies). Substantial heterogeneity precluded meta-analysis. Together with the evidence from the 2013 SLR, based on 15 studies, 7 at low risk of bias, patients on bDMARDs compared with patients on conventional sDMARDs had a higher risk of serious infections (adjusted HR (aHR) 1.1 to 1.8)—without differences across bDMARDs—a higher risk of tuberculosis (aHR 2.7 to 12.5), but no increased risk of infection by herpes zoster. Patients on bDMARDs did not have an increased risk of malignancies in general, lymphoma or non-melanoma skin cancer, but the risk of melanoma may be slightly increased (aHR 1.5).ConclusionsThese findings confirm the known safety pattern of bDMARDs, including both tumour necrosis factor-α inhibitor (TNFi) and non-TNFi, for the treatment of RA.

scholarly journals Association between Hidradenitis Suppurativa and Inflammatory Arthritis: A Systematic Review and Meta-Analysis

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nouf Almuhanna ◽  
Alexandra Finstad ◽  
Raed Alhusayen
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Odds Ratio ◽  
Inflammatory Arthritis ◽  
Hidradenitis Suppurativa ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Increased Risk ◽  
High Prevalence

<b><i>Background:</i></b> Several studies report a high prevalence of inflammatory arthritis among hidradenitis suppurativa (HS) patients. <b><i>Objectives:</i></b> To study the association between HS and inflammatory arthritis. <b><i>Methods:</i></b> The systematic review and meta-analysis were performed according to the PRISMA guidelines to identify the association between HS and inflammatory arthritis, spondyloarthritis, ankylosing spondylitis (AS), and rheumatoid arthritis (RA). <b><i>Results:</i></b> Seven studies were entered in the analysis, with 200,361 HS patients and 385,599 controls. Pooled analysis illustrated a significantly increased risk of inflammatory arthritis in HS patients compared to controls (odds ratio [OR] 3.44; 95% confidence interval [CI] 1.92–6.17). There was also a statistically significant association between HS and spondyloarthritis (OR 2.10; 95% CI 1.40–3.15), and between HS and AS (OR 1.89; 95% CI 1.14–3.12). Moreover, pooled analysis showed a statistically significant association between HS and RA (OR 1.96; 95% CI 1.28–2.98). <b><i>Conclusions:</i></b> Our findings show that HS patients have a 3-fold increased risk of developing inflammatory arthritis. HS patients are specifically at a higher risk for spondyloarthritis, its subtype AS, and RA.

Risk of malignancies using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis

2016 ◽  
Vol 15 (sup1) ◽  
pp. 35-54 ◽  
Author(s):  
Stefanos Bonovas ◽  
Silvia Minozzi ◽  
Theodore Lytras ◽  
Marien González-Lorenzo ◽  
Valentina Pecoraro ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Meta Analysis

scholarly journals Risk of Tuberculosis Reactivation in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis Receiving Non-Anti-TNF-Targeted Biologics

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Fabrizio Cantini ◽  
Carlotta Nannini ◽  
Laura Niccoli ◽  
Linda Petrone ◽  
Giuseppe Ippolito ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Underdeveloped Countries ◽  
Increased Risk ◽  
Tuberculosis Reactivation ◽  
Necrosis Factor

Tuberculosis (TB) still represents an important issue for public health in underdeveloped countries, but the use of antitumor necrosis factor agents (anti-TNF) for the treatment of inflammatory rheumatic disorders has reopened the problem also in countries with low TB incidence, due to the increased risk of TB reactivation in subjects with latent tuberculosis infection (LTBI). Over the last 5 years, several non-anti-TNF-targeted biologics have been licensed for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We reviewed the epidemiology of TB, the role of different cytokines and of the immune system cells involved in the immune response against TB infection, the methods to detect LTBI, and the risk of TB reactivation in patients exposed to non-anti-TNF-targeted biologics. Given the limited role exerted by the cytokines different from TNF, as expected, data from controlled trials, national registries of biologics, and postmarketing surveillance show that the risk of TB reactivation in patients receiving non-anti-TNF-targeted biologics is negligible, hence raising the question whether the screening procedures for LTBI would be necessary.

scholarly journals POS1086 DIFFERENCES IN PROINFLAMMATORY AND LIPID PROFILE BETWEEN PSORIATIC ARTHRITIS, ANKYLOSING SPONDYLITIS AND RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 822.2-822
Author(s):  
K. Bonek ◽  
E. Kuca-Warnawin ◽  
M. Ciechomska ◽  
P. Głuszko ◽  
E. Kontny
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Lipid Profile ◽  
Rheumatic Diseases ◽  
Internal Control ◽  
Premature Cardiovascular Disease ◽  
Increased Risk ◽  
Mixed Dyslipidemia ◽  
Intergroup Comparison

Background:Patients with rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) are at increased risk of developing dyslipidaemia and premature cardiovascular disease (CVD)(1).Objectives:To investigate the relationship between proinflammatory cytokines, microRNA, and lipid profile in patients with RA, AS, and PsA.Methods:A group of 65 patients (RA15/ AS25/ PsA25) with high disease activity (mean DAS28 5,98 / ASDAS-CRP 3,7/ DAPSA 38,5) and 25 healthy controls (HC) were compared. Lipid profile comprised triglycerides (TG), total cholesterol(TC), low (LDL), and high-density lipoprotein (HDL). Serum concentrations of IL-6, IL-21, IL-17, TNF and osteoprotegerine (OPG) were measured by commercially available enzyme-linked immunosorbent assays. Expression of miR-233-5p,miR-92-3p,miR-485-3p,miR-10b-5p,let-7d-5p, miR-26 -a-2-3p levels in sera was normalized to miR-16a internal control. The Mann-Whitney test was applied for intergroup comparison, the correlation was assessed using Spearman’s Rank test.Results:Patients with RA revealed mixed dyslipidemia (mean values:TC196; LDL 117; HDL, 48 TG; 124 mg/dl), PsA revealed hypertriglyceridemia (TC 175; LDL 100; HDL 50; TG137 mg/dl) and in AS no specific profile was found (TC 179; LDL98; HDL55; TG103 mg/dl). Higher expression of miR-485was observed in patients with PsA (4,8-fold) and AS (5,9-fold) compared to RA and HC groups (3,1 and 1,5-fold p=0,02). Similarly, miR-26a revealed higher expression in patients with PsA (28,4-fold) and AS (21,5-fold) than in RA and HC (3,5 and 2,9-fold p<0,00). PsA patients had higher expression of miR-146b than patients with RA, AS and HC (40,9-fold vs 12,6 vs 15,7 vs 3,4-fold p=0,002) and higher miR-10b (11,7 vs 1,4 vs 4,9 vs 1,7-fold p=0,004). Patients with RA showed higher expression of let7-d than patients with PsA, AS and HC (22-fold vs 1,8 vs 2,3 vs1,9 -fold p=0,002). In PsA miR-92b expression correlated negatively with HDL levels (r=-0,62 p=0,02) and positively with fasting glucose (r=0,71 p<0,00). TG levels negatively correlated with TNF (r=-0,47 p=0,01), IL-17 (r=-0,49 p=0,01) and OPG (r=-0,51 p=0,00) serum levels. Let-7d correlated negatively with TC (r=-0,58 p=0,03). In RA IL-21 positively correlated with LDL (r=0,71 p=0,00) and TC (r=0,75 p=0,001) concentrations. TG levels correlated positively with expressions of miR-92b (r=6,9 p=0,02) and miR-26a (r=0,69 p=0,03). In AS expression of let-7d was correlated positively with HDL (r=0,41 p=0,00) and TC (r=0,45 p=0,00) levels and negatively with ASDAS-CRP (r=-0,675 p=0,02) and CRP levels (r=-0,53 p=0,01). There were no significant differences in OPG, IL-21 concentrations or miR-146b, miR-92b,miR-233 expressions.Conclusion:Differences in proinflammatory profile in RA, PsA, and AS seem to be associated with different phenotypes of dyslipidemia. In PsA expression of miR-92b and higher levels of TNF, IL-17 and OPG are associated with altered lipid profile and hypertriglyceridemia. High activity of AS is associated with lowered expression of let-7d, possibly influencing TC and HDL levels. Therefore, measuring lipid profile in active disease might be misleading. In active RA increase of TC and LDL levels was associated with high IL-21 concentration, while hypertriglyceridemia with miR-92b and miR-26a expressions.References:[1]Bonek K,et al AB0775 Peripheral joint inflammation is associated with more proatherogenic cardiovascular risk profile in patients with psoriatic arthritis.Annals of the Rheumatic Diseases 2020;79:1685-1686Disclosure of Interests:None declared.

scholarly journals Central Nervous System Effects of Oral Propranolol for Infantile Hemangioma: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 8 (2) ◽  
pp. 268 ◽  
Author(s):  
Thuy Thai ◽  
Ching-Yu Wang ◽  
Ching-Yuan Chang ◽  
Joshua Brown
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Adverse Events ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Infantile Hemangioma ◽  
Risk Of Bias ◽  
Increased Risk ◽  
Cns Effects ◽  
Oral Propranolol

Concerns about the effects of propranolol on the central nervous system (CNS) in the infantile hemangioma (IH) population have been raised. We conducted a meta-analysis of the CNS and sleep-related effects of oral propranolol in IH patients. PubMed, Embase, Cochrance, Web of Science, and Clinicaltrials.gov were searched for relevant studies. We included clinical trials that compared oral propranolol with other treatments among IH patients under 6 years old and monitored and reported any adverse events. Study characteristics, types and number of adverse events were abstracted. Cochrane Collaboration Risk of Bias Tool was used to assess risk of bias. Our main outcomes were CNS and sleep-related effects. Random-effects models were used to estimate the pooled risk ratio. We did not observe statistically significant associations between oral propranolol and CNS or sleep-related effects. Oral propranolol appeared to have a safer profile of CNS effects than corticosteroids (RR = 0.27, 95% CI 0.02–3.00), but had an increased risk versus non-corticosteroids (for CNS effect, RR = 1.40, 95% CI 0.86–2.27; for sleep-related effects, RR = 1.63, 95% CI 0.88–3.03). Despite no statistically significant associations, there were suggestive findings of increased CNS effects and sleep-related risk of propranolol versus non-corticosteroids. In practice, CNS and sleep-related events should be monitored more closely among IH patients treated with oral propranolol.

scholarly journals Use of antidepressants and benzodiazepine-related hypnotics before and after initiation of TNF-α inhibitors or non-biological systemic treatment in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Philip Brenner ◽  
Anna Citarella ◽  
Louise Wingård ◽  
Anders Sundström
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Index Date ◽  
Psychiatric Symptoms ◽  
Autoimmune Disorders ◽  
Increased Risk ◽  
Sleeping Problems ◽  
Before And After ◽  
Population Controls

Abstract Background Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are autoimmune disorders associated with an increased risk for depression, anxiety and sleeping problems. The objective of this study was to analyze use of antidepressants and benzodiazepine-related hypnotics (BRH) in Sweden before and after first time treatment with anti-TNF and non-biological systemic (NBS) treatments among patients with the above diagnoses, and to correlate such use with that of randomly selected population controls. Methods Patients and dispensed drugs were identified in nationwide Swedish healthcare registers. Proportions of subjects filling prescriptions of antidepressants and BRH from 2 years before start of treatment (index-date), and 2 years after index date were assessed. Using the period -6 months to index-date as reference, prevalence rate ratios were computed for 6 months’ intervals before and after index. For up to ten randomly selected population controls per patient, the same measures were calculated. Results A total of 6256 patients started anti-TNF treatment, and 13,241 NBS treatment. The mean age at index was 52.0 for the anti-TNF group and 56.1 for NBS. Use of antidepressants and BRH was similar in both treatment groups (10.4–12.8%), significantly more common than in the controls (6.6 to 7.6%). For all patients, proportions filling prescriptions for antidepressants and BRH decreased directly or soon after the index; no such changes were seen in the controls, who all showed a slow but steady increase in use over time. Starters of anti-TNF treatment did not show clearer decreases in use of psychotropics than those initiating NBS. Conclusions Decreased rates of dispensed psychotropic drugs after the time of anti-TNF and NBS treatment initiation were seen among patients with autoimmune disorders but not population controls. This may correspond to treatment effects of anti-TNF and NBS also on psychiatric symptoms among these patients.

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