The effects of TNF-alpha inhibitor therapy on the incidence of infection in JIA children: a meta-analysis.

Pediatr Rheumatol Online J 2019 Jan 18;17(1). Epub 2019 Jan 18.

Department of Paediatrics, Medical School, University of Pécs, 7. József Attila street, Pécs, 7623, Hungary.

Background: Juvenile Idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. The diagnosis is based on the underlying symptoms of arthritis with an exclusion of other diseases Biologic agents are increasingly used on the side of disease-modifying anti-rheumatic drugs (DMARD) in JIA treatment.

Main Body: The aim of this meta-analysis was to investigate the observed infections in JIA children during tumor necrosis factor (TNF)-alpha inhibitor therapy. A systematic search of three databases (Medline via PubMed, Embase, Cochrane Library) was carried out up to May 2018. Published trials that evaluated the infectious adverse events in patients receiving TNF-alpha inhibitor vs. a control group were included in the analysis. Full-text data extraction was carried out independently by the investigators from ten relevant publications. 1434 patients received TNF-alpha inhibitor therapy; the control group consisted of 696 subjects. The analysis presented the risk of infection in the active treatment group (OR = 1.13; 95% CI: 0.76-1.69; p = 0.543). The majority of infections were upper respiratory tract infections (URTIs). Furthermore, the subgroup analysis demonstrated a higher infection rate in the observed localization.

Conclusion: Anti-TNF therapy slightly but not significantly increases the incidence of infection in JIA children compared to other therapies (GRADE: moderate evidence). The most common infections reported were mild URTIs. Further studies with larger patients number with a strong evidence level are crucially needed to finalize the answer whether anti-TNF therapy elevates and if yes on what extent the incidence of infection in JIA children.

Trial Registration: Prospero: CRD42017067873 .

Download full-text PDF

Source Listing

Still can't find the full text of the article?

We can help you send a request to the authors directly.
January 2019
17 Reads

Publication Analysis

Top Keywords

tnf-alpha inhibitor
inhibitor therapy
incidence infection
infection jia
jia children
anti-tnf therapy
control group
respiratory tract
cochrane library
embase cochrane
tract infections
pubmed embase
upper respiratory
infections urtis
2018 published
p = 0543 majority
published trials


(Supplied by CrossRef)
Article in J Rheumatol
R Merino et al.
J Rheumatol 2005
Article in Arthritis Care Res (Hoboken).
T Beukelman et al.
Arthritis Care Res (Hoboken). 2011
Article in Curr Rheumatol Rep
Y Sterba et al.
Curr Rheumatol Rep 2016
Article in Arthritis Rheum
DJ Lovell et al.
Arthritis Rheum 2008
Article in Ann Rheum Dis
P Lahdenne et al.
Ann Rheum Dis 2003
Article in N Engl J Med
DJ Lovell et al.
N Engl J Med 2008
Article in Arthritis Rheum
N Ruperto et al.
Arthritis Rheum 2007
Article in J Rheumatol
AL Smitten et al.
J Rheumatol 2008
Article in Arthritis Rheum
MF Doran et al.
Arthritis Rheum 2002
Article in Rheumatology (Oxford)
S Bernatsky et al.
Rheumatology (Oxford) 2007
Article in Arthritis Rheumatol.
H Yun et al.
Arthritis Rheumatol. 2016

Similar Publications