RA: National Consensus statement on TNFi and comorbidity

  • Conti F & al.
  • Rheumatology (Oxford)
  • 1 Oct 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A National Consensus Conference held in Italy concluded that patients with rheumatoid arthritis (RA) and comorbidities are less likely to respond to therapy with tumor necrosis factor inhibitors (TNFis) than those without comorbidities, among other conclusory statements.

Why this matters

  • Not enough professional guidance has been given about the efficacy of TNFi therapy in patients with RA with comorbidities, or about the effect of TNFi on the development of comorbidities.

Study design

  • Qualitative review of 10 longitudinal and cross-sectional studies that met eligibility criteria after an extensive literature review.
  • Final statements were voted on by 48 experts.
  • Funding: None.

Final statements

  • Patients with RA with comorbidities are less likely to achieve clinical response with TNFi therapy.
  • Solid cancer risk associated with TNFi therapy is no different from that associated with conventional synthetic disease-modifying antirheumatic drugs (DMARDs).
  • Breast cancer risk associated with TNFi therapy is not higher than that associated with conventional synthetic DMARDs.
  • Risk for serious infections is higher with TNFi therapy than with conventional DMARDs.
  • Having serious infections before starting TNFi therapy is not associated with increased risk for serious infections while receiving TNFi therapy.
  • Longer cumulative exposure to TNFi therapy is linked to a reduction in the risk for cardiovascular events.

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