All-cause Mortality Associated with TNF-α Inhibitors in Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials

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• 作者：Lucile Poiroux ; MD ; Yannick Allanore ; MD ; PhD ; André ; Kahan ; MD ; PhD ; Jé ; rô ; me Avouac ; MD ; PhD ; ^{jerome.avouac@cch.aphp.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Meta-analysis ; Mortality ; Rheumatoid arthritis ; TNF-α inhibitors
• 刊名：The American Journal of Medicine
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：128
• 期：12
• 页码：1367-1373.e1
• 全文大小：756 K

文摘

To compare mortality data obtained from randomized controlled trials for the 5 tumor necrosis factor-α (TNF-α) inhibitors used in the treatment of rheumatoid arthritis.

Methods

A systematic review of articles published up to November 2014 was performed using electronic databases. We included randomized, controlled trials, with a follow-up period of at least 24 weeks, comparing TNF-α inhibitors to placebo or disease-modifying antirheumatic drugs. The primary outcome was the occurrence of all-cause mortality.

Results

Twenty-three studies were selected. These articles included 6525 patients in the anti-TNF-α group and 3523 in the control group. The duration of patient follow-up ranged from 24 to 104 weeks. The risk of all-cause mortality in patients receiving TNF-α inhibitors was not significantly different from those receiving the comparator (odds ratio 1.32; 95% confidence interval, 0.76-2.29). Subgroup analyses with respect to the molecule used, the dose received, the use of TNF-α inhibitors as monotherapy or combination therapy, or the quality of the trial did not modify the findings.

Conclusion

This meta-analysis performed on a large number of patients and including the 5 TNF-α inhibitors currently available shows no increased risk of medium-term all-cause mortality in patients with rheumatoid arthritis.