Title:Infection and Malignancy Risk in Patients Treated with TNF Inhibitors for Immune-Mediated Inflammatory Diseases
Volume: 12
Issue: 3
Author(s): Rui Pereira, Raquel Faria, Paula Lago and Tiago Torres*
Affiliation:
- Department of Dermatology, Rua D. Manuel II, s/n, Servico de Dermatologia Centro Hospitalar do Porto, piso 1 4050-344 Porto,Portugal
Keywords:
Immune-mediated inflammatory diseases, infection, inflammatory bowel disease, malignancy, psoriasis, rheumathoid
arthritis, spondyloarthropathies, TNF inhibitors.
Abstract: Background: Infectious and malignant events are responsible for morbidity and mortality in
patients with Immune-Mediated Inflammatory Diseases (IMIDs). Anti-tumor necrosis factor (Anti-TNF)
agents appear to have an impact, however the individual effect of these agents in the different conditions
is still unclear.
Objective: The aim of this study is to estimate the Incidence Rates (IR) of infections and malignancies
in patients treated with anti-TNFs across different IMIDs, as well as potential risk factors.
Methods: IR/100 patient-years were evaluated in adult patients treated for any IMID with an anti-TNF
between January 2000 and December 2014. Predictors were tested with bivariate and multivariate
statistical analysis.
Results: The IR/100 patient-years of serious infections was 4.02 (95% CI 3.20-5.04) with significant
differences across IMIDs and anti-TNF agents. The most frequent site of serious infection was the
gastrointestinal system. Five cases [IR of 0.28 (95% CI 0.12-0.66) /100 patient-years] of tuberculosis
were diagnosed, exclusively in patients treated with monoclonal antibodies. Three (60%) of those were
extrapulmonary. The IR/100 patient-years of malignancy was 1.75 (95% CI 1.24-2-47).
Conclusion: There is significant variability in the IR of infections across indications and agents. Thus,
physicians should be thoughtful when generalizing data from literature regarding the use of an anti-TNF
agent in a specific IMID. Further studies are necessary to clear aspects regarding the safety of individual
anti-TNF biologics and to clarify their impact in the different IMIDs.
