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Meta-Analysis
. 2011 Jun;64(6):1035-50.
doi: 10.1016/j.jaad.2010.09.734. Epub 2011 Feb 18.

The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: a systematic review and meta-analysis of randomized controlled trials

Erica D Dommasch  1 , Katrina Abuabara, Daniel B Shin, Josephine Nguyen, Andrea B Troxel, Joel M Gelfand
Affiliations
Meta-Analysis

The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: a systematic review and meta-analysis of randomized controlled trials

Erica D Dommasch et al. J Am Acad Dermatol. 2011 Jun.

Abstract

Background: There is a need to better understand the safety of tumor necrosis factor (TNF) inhibitors in patients with psoriatic disease in whom TNF inhibitors are frequently used as monotherapy.

Objective: We sought to examine the risks of infection and malignancy with the use of TNF antagonists in adult patients with psoriatic disease.

Methods: We conducted a systematic search for trials of TNF antagonists for adults with plaque psoriasis and psoriatic arthritis. We included randomized, placebo-controlled trials of etanercept, infliximab, adalimumab, golimumab, and certolizumab for the treatment of plaque psoriasis and psoriatic arthritis. Twenty of 820 identified studies with a total of 6810 patients were included. Results were calculated using fixed effects models and reported as pooled odds ratios.

Results: Odds ratios for overall infection and serious infection over a mean of 17.8 weeks were 1.18 (95% confidence interval [CI] 1.05-1.33) and 0.70 (95% CI 0.40-1.21), respectively. When adjusting for patient-years, the incidence rate ratio for overall infection was 1.01 (95% CI 0.92-1.11). The odds ratio for malignancy was 1.48 (95% CI 0.71-3.09) and 1.26 (95% CI 0.39-4.15) when nonmelanoma skin cancer was excluded.

Limitations: Short duration of follow-up and rarity of malignancies and serious infections are limitations.

Conclusions: There is a small increased risk of overall infection with the short-term use of TNF antagonists for psoriasis that may be attributable to differences in follow-up time between treatment and placebo groups. There was no evidence of an increased risk of serious infection and a statistically significant increased risk in cancer was not observed with short-term use of TNF inhibitors.

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Figures

Figure 1
Figure 1
Selection of Studies for Meta-analysis
Figure 2
Figure 2
Odds Ratio (OR) of Malignancy Associated with Anti-TNF Treatment vs Control
Figure 3
Figure 3
Odds Ratio (OR) of Overall Infection Associated with Anti-TNF Treatment vs Control
See this image and copyright information in PMC

References

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    1. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: Results from NHANES 2003–2004. Journal of the American Academy of Dermatology. 2009;60:218–224. - PMC - PubMed

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