Assessing the Safety Profile of Targeted Immunomodulators in Patients with Arthritis

JANUARY 08, 2016
Andrew Smith
A systematic review of 61 studies found that infliximab (Remicade) was associated with more adverse events that led patients to discontinue treatment than abatacept (Orencia), adalimumab (Humira) or etanercept (Enbrel).
Investigators looking to compare the risks of 13 different targeted immunomodulators gathered 51 observational studies and 10 randomized controlled trials that made head-to-head comparisons. They then gathered data on the following outcomes: number of adverse events, discontinuation due to adverse events, serious adverse events, mortality, serious infections, tuberculosis, herpes zoster, and malignancies. Finally, in cases where 3 or more studies provided data on a particular outcome from a particular medication, they synthesized the studies and conducted random effects meta-analyses.
A majority of the studies (70%) reported on patients with rheumatoid arthritis but the underlying research also included patients with ankylosing spondylitis, inflammatory bowel diseases, juvenile idiopathic arthritis, plaque psoriasis, psoriatic arthritis. 
“Important differences were noted in the safety profile of targeted immunomodulators in rheumatoid arthritis, generally favoring abatacept, adalimumab, and etanercept over infliximab,” the investigators wrote in Arthritis Care & Research. “Risk of treatment discontinuation due to adverse events was higher with infliximab than with adalimumab or etanercept in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A higher risk for serious infections was noted with infliximab than with abatacept, adalimumab, or etanercept in rheumatoid arthritis.”
Analysis of 6 observational studies that compared etanercept and infliximab found that etanercept patients were about half as likely as infliximab patients to stop treatment due to adverse events (pooled hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.42 to 0.68).
Analysis of 4 observational studies that compared adalimumab and infliximab found that adalimumab patients were also about half as likely as infliximab patients to stop treatment due to adverse events (pooled HR 0.57; 95% CI, 0.46 to 0.70).

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