Risk of Active Tuberculosis During Anti-TNF-α Inhibitor Use to Treat Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Given the wide application of TNF-α inhibitors for the treatment of rheumatoid arthritis (RA), more active tuberculosis cases have been reported in patients with RA. This meta-analysis was performed to evaluate the risk of active tuberculosis (TB) in RA patients undergoing treatment with TNF-α inhibitors. Methods and Results: Thirty randomized controlled trials (RCTs), comprising 18,640 patients, were included in the meta-analysis after searching PubMed, EMBASE, and Web of Science databases. Overall, there was a higher risk of active TB in patients with RA undergoing treatment with TNF-α inhibitors than in the control group (Peto OR, 2.57; 95%CI, 1.42-4.66; P=0.002). Conclusion: Our meta-analysis showed that RA patients treated with TNF-α inhibitors had a higher risk of developing active TB. Tuberculosis screening should be performed before and during the use of TNF-α inhibitors in these patients.

Keywords

• rheumatoid arthritis
• tuberculosis
• tnf-α inhibitor
• meta-analysis