One of the important issues with these results is the potential lack of power. the MantelCHaenszel method with a continuity correction. Data synthesis: Twelve randomised controlled trials with data concerning serious infections were analysed (three for rituximab, five for abatacept and four for anakinra). They included 745 patients, 1960 patients, 2062 patients and 2112 patients treated by rituximab, abatacept, anakinra and placebo respectively. The overall pooled ORs did not reveal a statistically significant increased risk of serious infection for abatacept and Rosiglitazone maleate rituximab; this risk was increased for high doses of anakinra (?100 mg daily) versus low dose and placebo (ORs?=?9.63 (95% CI, 1.31 to 70.91) and 3.40 (95% CI, 1.11 to 10.46) respectively). Conclusions: These meta-analyses did not reveal a significant increase in the risk of serious infections during rituximab or abatacept treatments in patients with rheumatoid arthritis; however, high doses of anakinra may increase this risk, especially when patients have comorbidity factors. Large studies must be performed to confirm this safety profile in daily practice. Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterised by chronic polyarticular synovial inflammation that may lead to irreversible joint damage with disability and deformity. This joint inflammation is Rabbit Polyclonal to OR2A42 a result of the excessive production by activated T cells of pro-inflammatory cytokines, such as tumour necrosis factor (TNF) , interleukin (IL)-1, IL-6, and the stimulation of immunoglobulin production by B cells. The conventional treatment of RA combines corticosteroids and disease-modifying anti-rheumatic medicines (DMARDs), in particular, methotrexate. However, RA may remain active despite such treatments. Since 1997, fresh treatments based on biological agents have shown their effectiveness in RA. Biotherapies have different therapeutic focuses on and some are targeted against pro-inflammatory cytokines: three TNF- blockers are available, infliximab, etanercept and adalimumab1C7 and one IL-1 receptor antagonist, anakinra.8 Down-regulation of T cell activation is achieved by the recombinant human being fusion protein CTLA-4-immunoglobulin G (abatacept)9 and B cells are the selective target of the chimeric anti-CD20 monoclonal antibody (rituximab).10 Before the biotherapy era, it was reported the incidence rate of infections in the RA populace was nearly twice as high as with matched non-RA settings.11 This is thought to be related to the disease itself, which alters immunological functions, decreases mobility and causes pores and skin defects, and also to immunosuppressive medicines, in particular concomitant use of steroids.11 12 In post-marketing monitoring and observational studies of TNF- blockers, serious infections (defined as life-threatening or requiring intravenous antibiotics or hospitalisation) look like the most frequent adverse event having a prevalence of 6C18% and an incidence rate of approximately 6 per 100 patient-years.13C15 Furthermore, caseCcontrol studies, carried out in routine daily practice, showed that the risk of serious infections was two- to three-fold higher in patients receiving Rosiglitazone maleate TNF- blockers compared with those not treated with such treatment.13C16 Thus it is clear that TNF- blockers can increase immunosuppression in individuals with Rosiglitazone maleate RA and induce the emergence of serious infections. Meta-analysis is an interesting method to detect such a risk of a relatively rare event: a recent meta-analysis of randomised placebo-controlled tests of monoclonal anti-TNF- antibodies (infliximab, adalimumab) found a pooled odds percentage (OR) for severe infections of 2.0 (95% confidence interval (CI), 1.3 to 3.1) in TNF- blocker treated individuals.17 However, individually, the tests had failed to demonstrate this increased risk of serious infections. For other biological providers that may interfere with the immune response (rituximab, anakinra, abatacept), data on severe infections are lacking. The purpose of this study was to assess if these biotherapies improved the risk of serious infections in individuals with RA, by carrying out a meta-analysis of data published to date. METHODS For each biological agent, a meta-analysis was carried out according to the Cochrane Collaboration guidelines.18 Study selection A systematic literature search of the literature published up to December 2007 was performed in PUBMED, EMBASE and Cochrane library databases; without limitation of years of publication or journal, using the followings key-words: rheumatoid arthritis, abatacept, rituximab, anakinra, medical controlled trials, medical trials, randomised controlled trials, clinical.
