TNF Inhibitors Double Infection Risk

At 1 year, tumor necrosis factor inhibitors were associated with excess risk for serious infections in rheumatoid arthritis patients.

Tumor necrosis factor-α (TNF) inhibitors raise risk for infection in patients with rheumatoid arthritis. To quantitate this risk, Japanese investigators compared outcomes in 646 patients who were treated with TNF inhibitors (etanercept [Enbrel] or infliximab [Remicade]) and 498 patients who were treated with nonbiologic disease-modifying antirheumatic drugs. Median follow-up was about 1 year in both groups.

Thirty-eight serious infections occurred in the TNF-inhibitor group (25 bacterial, 11 opportunistic, and 2 other), and 12 occurred in the unexposed group (6.4 vs. 2.6 infections per 100 person-years). In a multivariate analysis that was controlled for baseline differences between the two groups, TNF-inhibitor exposure doubled risk for serious infection. Within the TNF-inhibitor group, older age and corticosteroid use were independent predictors of serious infection.

Comment: In this Japanese cohort, elevated risk for infection conferred by TNF inhibitors was similar to that observed in some European and American populations. Clinicians should be vigilant about infectious complications in patients with rheumatoid arthritis who are receiving TNF inhibitors.

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