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Clinical Reviews in Allergy & Immunology

, Volume 54, Issue 2, pp 234–243 | Cite as

The Comparative Safety of TNF Inhibitors in Ankylosing Spondylitis—a Meta-Analysis Update of 14 Randomized Controlled Trials

  • Li-qiong Hou
  • Ga-xue Jiang
  • Yan-fei Chen
  • Xi-Mei Yang
  • Lei Meng
  • Miao Xue
  • Xiao-guang Liu
  • Xi-chao Chen
  • Xiao Li
Article
  • 540 Downloads

Abstract

TNF inhibitors have been used in ankylosing spondylitis (AS). The efficacy of TNF inhibitors was already evaluated by meta-analysis of randomized controlled trials (RCTs). However, the safety of TNF inhibitors is still unclear. Therefore, we aimed to evaluate and update the safety data from RCTs of TNF inhibitors in patients treated for AS. A systematic literature search was conducted from 1990 through May 31, 2016. All studies included were randomized, double-blind, controlled trials of patients with ankylosing spondylitis that evaluated adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab treatment. The overall serious adverse events, the risk of serious infection events, and the risk of malignancy and discontinuation rates were abstracted, and risk estimates were calculated by Peto odds ratios (ORs). Fourteen randomized controlled trials involving 2032 subjects receiving TNF inhibitors and 1030 subjects receiving placebo and/or traditional disease-modifying anti-rheumatic drugs (DMARDs) were included. The overall serious adverse events (OR, 1.34; 95% CI, 0.87–2.05), the risk of serious infection events (OR, 1.59; 95% CI, 0.63–4.01), the risk of malignancy (OR, 0.98; 95% CI, 0.25–3.85), and discontinuation due to adverse events (OR, 1.55; 95% CI, 0.95–2.54) in patients treated with TNF inhibitors as a group were not significantly different from those treated with placebo in the control group. TNF inhibitors were generally safe for treatment of ankylosing spondylitis. These data may help guide clinical comparative decision making in the management of AS.

Keywords

Ankylosing spondylitis TNF inhibitors Safety Adverse events Meta-analysis 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Not applicable.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of RheumatologyThe First Hospital of Lanzhou UniversityLanzhouChina
  2. 2.Department of CardiologyThe First Hospital of Lanzhou UniversityLanzhouChina
  3. 3.Department of Evidence-Based Medicine CenterThe First Hospital of Lanzhou UniversityLanzhouChina

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