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Anti-TNF Findings Presented at European Conference

by Cooper B. Wilhelm

Last week, scientists and researchers from all over the world convened in Berlin for the European League Against Rheumatism's (EULAR) annual conference. Dozens of teams presented studies, many of which revealed new information about a class of drugs called tumor necrosis factor (TNF) inhibitors.

TNF inhibitors, also known as anti-TNF drugs, are used to treat rheumatoid arthritis (RA), psoriatic arthritis, and other inflammatory conditions. Common anti-TNF drugs include adalimumab (brand name Humira), etanercept (Enbrel), and infliximab (Remicade). While some studies presented at the conference confirmed the positive effects of anti-TNF drugs, others highlighted potential risks associated with the drugs.

Given the moderately increased risk of bacterial infection associated with anti-TNF drug use, researchers at a French hospital conducted a meta-study to determine the extent to which anti-TNF medicines increased the risk of developing herpes zoster. Also known as shingles, herpes zoster is a reactivated form of previously dormant chickenpox virus. After reviewing 22 studies and 28 abstracts, the researchers determined that people taking anti-TNF drugs were up to 75% more likely to develop shingles.

Another study found that people taking anti-TNF drugs to treat a form of arthritis called ankylosing spondylitis were as likely to develop tuberculosis as people taking anti-TNF drugs for RA, though people with ankylosing spondylitis tended to do so later than people with RA. A study presented at the conference also found that, as successful as anti-TNF drugs can be in treating RA, smoking decreases the likelihood that they will be effective. Previous research had already indicated the negative effects of smoking on the efficacy of anti-TNF drugs in people with RA, but this study was the largest of its kind, following 2,811 people with RA who had just started taking TNF inhibitors for the first time. Although there was no difference in the likelihood of smokers or nonsmokers achieving at least a moderate response, at the end of six months, disease activity among smokers was significantly higher.

However, the anti-TNF news from the conference was not all bad. Indeed, far from it.

German researchers determined that although people with RA had a higher mortality rate than the general population, people taking anti-TNF drugs had almost half (65%) the mortality rate of people taking disease modifying antirheumatic drugs (DMARDs).

Another study conducted by researchers from the United States and the Netherlands looked at what effect anti-TNF drugs, methotrexate, and nonbiologic DMARDs had on the increased risk of cardiovascular events associated with RA. Of the three, only anti-TNF drugs produced any significant decrease in risk. Furthermore, researchers found that anti-TNF drugs not only decreased the risk of a cardiovascular event, but they also decreased it more with every six months of use. Using a mathematical model, the researchers predicted that continued use of anti-TNF drugs would reduce the risk of a cardiovascular event 24% after 1 year, 42% after 2 years, and 56% after 3 years.

Researchers from the United States, the Netherlands, Sweden, Germany, and Belgium examined the effects of an anti-TNF drug called certolizumab pegol (brand name Cimzia) on psoriatic arthritis. After testing certolizumab pegol at various doses in people with active psoriatic arthritis, researchers found that the anti-TNF drug was more than twice as effective as a placebo, while remaining about as safe as it is in treating people with RA.

The results of these studies are compelling, but it should be noted that all of these findings are from abstracts presented at a conference. None of them have been published, and so they have yet to be peer-reviewed.

Last Reviewed on June 14, 2012

Cooper B. Wilhelm is an Editorial Assistant at Arthritis Self-Management.

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