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Risk of tuberculosis during infliximab therapy for inflammatory bowel disease, rheumatoid arthritis, and spondyloarthropathy: A meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Infliximab is a promising drug with good outcomes demonstrated for diseases such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA) and spondyloarthropathy (SpA). However, treatment with this drug may increase the risk of tuberculosis infection. The aim of the present study was to investigate infliximab-associated tuberculosis infection. Literature searches in PubMed, MEDLINE and EMBASE databases were performed. Randomized controlled trials with >95% of the patients >18 years-old were included. Meta-analysis was performed to investigate the incidence of tuberculosis infection after infliximab infusion. A total of 24 RCTs were included in the present meta-analysis. In total, 21 (0.51%) tuberculosis infections were detected among 4,111 patients administered infliximab therapy, compared with 0 (0%) among 2,229 patients assigned to the placebo group. Pooled odds ratio (OR) of developing tuberculosis infection was significantly higher with infliximab therapy than with placebo [2.86; 95% confidence interval (CI), 1.09–7.52]. The OR of tuberculosis infection was 3.93 (95% CI, 0.91–16.91) in RA, 2.46 (95% CI, 0.38–15.92) in SpA and 1.66 (95% CI, 0.26–10.57) in IBD. Rates of tuberculosis infection with infliximab therapy in RA, SpA and IBD were 0.70, 0.22 and 0.52%, respectively. Compared with placebo, infliximab therapy may increase the risk of developing tuberculosis. However, the ORs for the risk of infliximab-associated tuberculosis were not demonstrated to be significant in IBD, RA and SpA; therefore, these findings should be interpreted with caution. The risk of developing tuberculosis demonstrates the importance of the prevention and management of tuberculosis infection with infliximab therapy.

No MeSH data available.


Flowchart of study selection process. RCT, randomized controlled trial.
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f1-etm-0-0-3548: Flowchart of study selection process. RCT, randomized controlled trial.

Mentions: The present search strategy identified 6,892 articles, 6,553 of which were excluded after the title and abstract were reviewed. For the remaining 339 articles, 316 articles were excluded due to duplication (n=54), not being an RCTs (n=127), a lack of placebo (n=67), no outcome of interest (n=49), and no data on tuberculosis (n=19). Finally, 23 articles were included in the present meta-analysis, reporting on 24 respective RCTs. Of these, 8 studies studied infliximab-associated tuberculosis incidence in IBD (24–32), one of which reported two separate trials (29), 7 trials studied infliximab-associated tuberculosis incidence rates in RA (33–39), and 8 trials studied infliximab-associated tuberculosis incidence in SpA (40–47). A flow diagram of the selection process for the inclusion of studies in the present meta-analysis is shown in Fig. 1.


Risk of tuberculosis during infliximab therapy for inflammatory bowel disease, rheumatoid arthritis, and spondyloarthropathy: A meta-analysis
Flowchart of study selection process. RCT, randomized controlled trial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998002&req=5

f1-etm-0-0-3548: Flowchart of study selection process. RCT, randomized controlled trial.
Mentions: The present search strategy identified 6,892 articles, 6,553 of which were excluded after the title and abstract were reviewed. For the remaining 339 articles, 316 articles were excluded due to duplication (n=54), not being an RCTs (n=127), a lack of placebo (n=67), no outcome of interest (n=49), and no data on tuberculosis (n=19). Finally, 23 articles were included in the present meta-analysis, reporting on 24 respective RCTs. Of these, 8 studies studied infliximab-associated tuberculosis incidence in IBD (24–32), one of which reported two separate trials (29), 7 trials studied infliximab-associated tuberculosis incidence rates in RA (33–39), and 8 trials studied infliximab-associated tuberculosis incidence in SpA (40–47). A flow diagram of the selection process for the inclusion of studies in the present meta-analysis is shown in Fig. 1.

View Article: PubMed Central - PubMed

ABSTRACT

Infliximab is a promising drug with good outcomes demonstrated for diseases such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA) and spondyloarthropathy (SpA). However, treatment with this drug may increase the risk of tuberculosis infection. The aim of the present study was to investigate infliximab-associated tuberculosis infection. Literature searches in PubMed, MEDLINE and EMBASE databases were performed. Randomized controlled trials with >95% of the patients >18 years-old were included. Meta-analysis was performed to investigate the incidence of tuberculosis infection after infliximab infusion. A total of 24 RCTs were included in the present meta-analysis. In total, 21 (0.51%) tuberculosis infections were detected among 4,111 patients administered infliximab therapy, compared with 0 (0%) among 2,229 patients assigned to the placebo group. Pooled odds ratio (OR) of developing tuberculosis infection was significantly higher with infliximab therapy than with placebo [2.86; 95% confidence interval (CI), 1.09–7.52]. The OR of tuberculosis infection was 3.93 (95% CI, 0.91–16.91) in RA, 2.46 (95% CI, 0.38–15.92) in SpA and 1.66 (95% CI, 0.26–10.57) in IBD. Rates of tuberculosis infection with infliximab therapy in RA, SpA and IBD were 0.70, 0.22 and 0.52%, respectively. Compared with placebo, infliximab therapy may increase the risk of developing tuberculosis. However, the ORs for the risk of infliximab-associated tuberculosis were not demonstrated to be significant in IBD, RA and SpA; therefore, these findings should be interpreted with caution. The risk of developing tuberculosis demonstrates the importance of the prevention and management of tuberculosis infection with infliximab therapy.

No MeSH data available.