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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.


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Risk of bias in 24 randomized controlled trials of tuberculosis infection with infliximab therapy.
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f3-etm-0-0-3548: Risk of bias in 24 randomized controlled trials of tuberculosis infection with infliximab therapy.

Mentions: Subgroup analyses were performed (Table IV). The OR of tuberculosis infection with infliximab therapy was elevated in trials with ≥50 weeks of treatment (3.00; 95% CI, 0.97–9.29), as compared with those with a duration of <50 weeks (2.46; 95% CI, 0.38–15.92); however, there was no statistically significance (Cochran Q=0.03; P=0.86). Furthermore, the OR was also increased in the larger sample studies (2.94; 95% CI, 0.87–9.94), as compared with the smaller sample studies (2.71; 95% CI, 0.55–13.26); however, again there was no significant differences detected (Cochran Q=0.01; P=0.93). There were also no significant differences in the OR of tuberculosis infection with infliximab therapy accompanied with or without immunosuppressor (2.96; 95% CI, 0.94–9.29; and 2.59; 95% CI, 0.42–15.92; respectively, Cochran Q=0.02, P=0.90). When screening for tuberculosis prior to the examination of therapy according to the study design, the OR was also increased in trials that screened for tuberculosis (3.10; 95% CI, 1.04–9.21), as compared with those without screening (2.09; 95% CI, 0.26–17.13) (Cochran Q=0.11, P=0.74). Finally, risk of bias was judged in the RCTs (Fig. 3), the OR was elevated in trials with high or unclear risk (3.14; 95% CI, 0.93–10.54), as compared with those at low risk (2.35; 95% CI, 0.47–11.77); however, there was also no significant differences detected (Cochran Q=0.08; P=0.78). The results showed that subgroup differences did not increase the risk of tuberculosis infection with infliximab therapy compared with placebo.


Risk of tuberculosis during infliximab therapy for inflammatory bowel disease, rheumatoid arthritis, and spondyloarthropathy: A meta-analysis
Risk of bias in 24 randomized controlled trials of tuberculosis infection with infliximab therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-etm-0-0-3548: Risk of bias in 24 randomized controlled trials of tuberculosis infection with infliximab therapy.
Mentions: Subgroup analyses were performed (Table IV). The OR of tuberculosis infection with infliximab therapy was elevated in trials with ≥50 weeks of treatment (3.00; 95% CI, 0.97–9.29), as compared with those with a duration of <50 weeks (2.46; 95% CI, 0.38–15.92); however, there was no statistically significance (Cochran Q=0.03; P=0.86). Furthermore, the OR was also increased in the larger sample studies (2.94; 95% CI, 0.87–9.94), as compared with the smaller sample studies (2.71; 95% CI, 0.55–13.26); however, again there was no significant differences detected (Cochran Q=0.01; P=0.93). There were also no significant differences in the OR of tuberculosis infection with infliximab therapy accompanied with or without immunosuppressor (2.96; 95% CI, 0.94–9.29; and 2.59; 95% CI, 0.42–15.92; respectively, Cochran Q=0.02, P=0.90). When screening for tuberculosis prior to the examination of therapy according to the study design, the OR was also increased in trials that screened for tuberculosis (3.10; 95% CI, 1.04–9.21), as compared with those without screening (2.09; 95% CI, 0.26–17.13) (Cochran Q=0.11, P=0.74). Finally, risk of bias was judged in the RCTs (Fig. 3), the OR was elevated in trials with high or unclear risk (3.14; 95% CI, 0.93–10.54), as compared with those at low risk (2.35; 95% CI, 0.47–11.77); however, there was also no significant differences detected (Cochran Q=0.08; P=0.78). The results showed that subgroup differences did not increase the risk of tuberculosis infection with infliximab therapy compared with placebo.

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 &gt;95% of the patients &gt;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&ndash;7.52]. The OR of tuberculosis infection was 3.93 (95% CI, 0.91&ndash;16.91) in RA, 2.46 (95% CI, 0.38&ndash;15.92) in SpA and 1.66 (95% CI, 0.26&ndash;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.


Related in: MedlinePlus