What are the risks of anti-tumor necrosis factor (TNF) therapy in rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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The results of one study noted that the use of anti-TNF therapy may double the risk of septic arthritis in patients with RA, with the risk being highest in the early months of therapy. Although not significantly influenced by anti-TNF therapy, previous joint replacement surgery was also noted as a risk factor for septic arthritis. [76]

Hepatitis B virus (HBV) reactivation can occur in both hepatitis B surface antigen (HBsAg)–positive and HBsAg-negative/hepatitis B core antibody (anti-HBc)-positive patients with detectable occult HBV infection during anti−TNF-α therapy. Antiviral prophylaxis may effectively reduce this reactivation. [77]

In three Swedish registries that analyzed the cancer risk in 6366 RA patients taking TNF inhibitors, no increased risk of cancer with these agents was observed. [78] These patients were compared with 61,160 biologics-naive RA patients, 5989 patients starting MTX, 1838 patients starting DMARD combination therapy, and the general Swedish population. Of patients taking TNF inhibitors, 240 developed first-time cancer, yielding a relative risk (RR) of 1.00 compared with the biologics-naive cohort. Similar RRs were shown with the other cohorts.

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