Malignancy, Infection Risk in Early RA May Not Increase With TNF-α Inhibitors

July 28, 2011

In this meta-analysis, the risk of malignancy or serious infections was not increased in patients with a new diagnosis of rheumatoid arthritis (RA) who received tumor necrosis factor α (TNF-α) inhibitor therapy and had not received disease-modifying antirheumatic drugs (DMARDs) or methotrexate (MTX). This finding runs contrary to the results of earlier meta-analyses.

In this meta-analysis, the risk of malignancy or serious infections was not increased in patients with a new diagnosis of rheumatoid arthritis (RA) who received tumor necrosis factor α (TNF-α) inhibitor therapy and had not received disease-modifying antirheumatic drugs (DMARDs) or methotrexate (MTX). This finding runs contrary to the results of earlier meta-analyses.

Thompson and coworkers performed a systematic literature search. All studies included were randomized controlled trials involving patients with early RA for whom TNF-α inhibitor therapy was started without previous DMARD or MTX use. The 6 trials that met the inclusion criteria included 2183 patients receiving biologic therapy and 1236 patients receiving MTX.

A serious infection occurred in 3.3% of the patients who had received at least 1 dose of a TNF-α inhibitor, compared with 2.4% of patients in the control treatment groups. Malignancies occurred in 0.87% of the patients who had received at least 1 dose of a TNF-α inhibitor, compared with 0.81% of control patients. There was no significant difference between the groups in the rate of serious infections or that of
malignancies.

The authors noted that further review of this patient population in an observational inception cohort would help confirm and strengthen their findings.