分析长期治疗数据显示TNF拮抗剂似乎并未增加严重感染和肿瘤发生风险

原文

译文

J Rheumatol. 2011 Aug;38(8):1552-62. Epub 2011 May 15.   Does Anti-Tumor Necrosis Factor-{alpha} Therapy Affect Risk of Serious Infection and Cancer in Patients with Rheumatoid Arthritis?: A Review of Longterm Data.   Keystone EC.   Source Professor of Medicine, University of Toronto, 60 Murray Street, Room 2-006, Box 4, Toronto, ON M5T 3L9, Canada. edkeystone@mtsinai.on.ca.   Abstract Given the important role tumor necrosis factor-α (TNF-α) antagonists play in managing rheumatoid arthritis and the concern for safety during longterm therapy, we reviewed the latest evidence regarding longterm risk of infection and malignancy with TNF-α antagonists. Our objective was to provide clinicians with information that can be used to counsel and monitor patients who may be candidates for biologic therapy for rheumatoid arthritis (RA). Risk is examined in the context of background infection and malignancy rates in RA. Randomized controlled trial (RCT) data and observational studies summarizing the risk of infection and/or malignancy in RA and specific risks associated with the use of anti-TNF-α biologic agents (adalimumab, infliximab, and etanercept) were identified through a PubMed search. Overall, patients with RA appear to have an approximately 2-fold increased risk of serious infection compared to the general population and non-RA controls, irrespective of TNF-α antagonist use. Although data on infection rates with TNF-α antagonist use are contradictory, caution is merited. Recent analyses suggest that the risk of infection is highest within the first year. Regarding malignancy risk, RCT and observational data are also conflicting; how ever, caution is warranted regarding lymphoproliferative cancers in children and adolescents.   PMID: 21572154

分析长期治疗数据显示TNF拮抗剂似乎并未增加严重感染和肿瘤发生风险   Keysone EC. J Rheumatol. 2011. 38:1552-62.       考虑到肿瘤坏死因子-α（TNF -α）拮抗剂在类风湿关节炎治疗中的重要作用以及大家对药物安全性的关注，我们评估了与长期使用TNF拮抗剂后感染和恶性肿瘤发生风险相关的最新证据。     研究目标为临床医生提供信息，有助于他们为适于接受生物制剂治疗RA病人提供咨询并在用药过程中进行安全性监测。相关风险因素包括感染和肿瘤。     我们通过PubMed检索随机对照试验(RCT)和观察性研究，从而总结RA病人的感染和/或肿瘤发生风险，并计算TNF拮抗剂治疗(阿达木、英夫利昔和依那西普)相关的特异风险。 总体而言，RA病人感染风险较总人群和非RA对照人群增加2倍，这与是否使用TNF拮抗剂无关。尽管对抗TNF治疗相关感染率的数据尚存争议，但保持临床警惕性还是值得的。仅有研究提示使用抗TNF治疗第一年的感染风险是最高的。 至于恶性肿瘤发生风险，RCT和观察性数据也存在冲突性，但是应该警惕儿童及青春期前少年中的淋巴增生性肿瘤。