The Pharmaceutical Journal
Vol 277 No 7407 p6
1 July 2006

This article
Reprint   Photocopy

  Acrobat Reader

TNF inhibitor infection risk coupled with lower CV risk

?Tumour necrosis factor (TNF) inhibitors increase patients’ risk of being admitted to hospital for infection, but appear to reduce their cardiovascular risk, two studies presented at the Annual European Congress of Rheumatology in Amsterdam last week suggest.

Johan Askling, from the Karolinska Institute in Stockholm, used the Swedish inpatient register to examine hospital admissions for infection and the Swedish programme that monitors biologics in rheumatoid arthritis to look at the admission rates among those taking TNF inhibitors. They found that, of 4,160 patients taking TNF inhibitors, 2,465 were admitted to hospital for infection and calculated that TNF inhibitors were associated with a 39 per cent increased risk of being admitted to hospital for infection (adjusted relative risk 1.39; 95 per cent confidence interval 1.23–1.57).

The reason for this increase was not clear, Dr Askling said. “However, since part of the drugs’ action is to interfere with the body’s normal defence against infections, some degree of risk increase is conceivable,” he added.

William Dixon, from the University of Manchester, followed 8,076 patients who had not previously taken TNF inhibitors and compared them with 1,351 patients taking disease-modifying anti-rheumatic drugs. TNF inhibitors appeared to reduce rates of hospital admission from cerebrovascular accidents and myocardial infarctions (odds ratios 0.50, CI 0.24–1.05, and 0.72, CI 0.30–1.77, respectively). “This study has suggested that [TNF inhibitors] specifically reduce the risk of myocardial infarction and cerebrovascular accidents, which are two of the most serious cardiovascular events, often leading to death,” Dr Dixon said.

However, other results suggested that more still needs to be done to reduce mortality from cardiovascular disease in rheumatoid arthritis. Ulf Bergström, from the University of Malmö, Sweden, presented an evaluation of mortality changes in rheumatoid arthritis patients from 1978 to 1995. He studied cardiovascular morbidity and mortality in 309 patients with established rheumatoid arthritis treated at outpatient clinics in Sweden and found no change in the excess mortality from cardiovascular disease from 1978 to 2005, despite a decrease in overall mortality. “The management of the disease has changed significantly over the decades and this study gives an excellent measurement of whether this has improved cardiovascular events experienced by rheumatoid arthritis patients,” Dr Bergström said. “It shows that further action is necessary in order to reduce additional mortality in rheumatoid arthritis.”