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ACP Journal Club |16 February 2016

Review: In rheumatoid arthritis, TNF-α inhibitors do not differ from placebo or DMARDs for all-cause mortality

Ami Schattner, MD

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Poiroux L, Allanore Y, Kahan A, Avouac J. All-cause mortality associated with TNF-alpha inhibitors in rheumatoid arthritis: a meta-analysis of randomized controlled trials. Am J Med. 2015. [Epub ahead of print] 26247564

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Rheumatology:

In adults with rheumatoid arthritis (RA), what is the effect of tumor necrosis factor (TNF)-α inhibitors on all-cause mortality?
Included English-language studies compared available TNF-α inhibitors (adalimumab, etanercept, certolizumab, infliximab, or golimumab) with placebo or disease-modifying antirheumatic drugs (DMARDs) for ≥ 24 weeks in adults with RA. Primary outcome was all-cause mortality.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Library, Google Scholar (all Jan 2000 to Nov 2014), and reference lists were searched for randomized controlled trials (RCTs). 23 RCTs (n = 10 048, median follow-up 46 wk) met selection criteria; 14 were rated as high quality. TNF-α inhibitors included adalimumab (8 RCTs), etanercept (3 RCTs), certolizumab (4 RCTs), infliximab (6 RCTs), and golimumab (2 RCTs). Comparators were placebo (3 RCTs), methotrexate monotherapy (17 RCTs), DMARDs (2 RCTs), and sulfasalazine (1 RCT).
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Schattner A. Review: In rheumatoid arthritis, TNF-α inhibitors do not differ from placebo or DMARDs for all-cause mortality. Ann Intern Med. ;164:JC20. doi: 10.7326/ACPJC-2016-164-4-020

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Published: Ann Intern Med. 2016;164(4):JC20.

DOI: 10.7326/ACPJC-2016-164-4-020

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