Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn's disease: a meta-analysis.
Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn's disease: a meta-analysis.
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DOI：
10.1016/j.cgh.2009.01.004
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发表时间：
2009-08
期刊：
影响因子：
--
通讯作者：
Sands BE
中科院分区：
文献类型：
--
作者：
Siegel CA;Marden SM;Persing SM;Larson RJ;Sands BE
虽然抗肿瘤坏死因子（TNF）疗法可以有效治疗克罗恩病（CD），但人们担心它可能会增加非霍奇金淋巴瘤（NHL）的风险。进行了一项荟萃分析，以确定接受抗tnf治疗的成年CD患者的NHL发病率，并将这一发病率与基于人群的登记和接受免疫调节剂治疗的CD患者的发病率进行比较。检索了MEDLINE、EMBASE、Cochrane Collaboration和Web of Science。纳入标准包括随机对照试验、队列研究或报告成人CD患者抗tnf治疗的病例系列。标准化发病率（SIR）是通过比较NHL的合并发病率与来自监测流行病学和最终结果（SEER）数据库的NHL预期发病率以及接受免疫调节剂治疗的CD患者的荟萃分析来计算的。纳入了26项研究，涉及8905例患者和21,178例患者年的随访。在抗tnf治疗的受试者中，报告了13例NHL（6.1 / 10,000患者年）。这些患者中的大多数以前都接触过免疫调节剂。与SEER数据库中NHL的预期发生率（1.9 / 10,000患者-年）相比，抗tnf治疗的受试者风险显著升高（SIR, 3.23； 95%可信区间，1.5-6.9）。与单独接受免疫调节剂治疗的CD患者的NHL发生率（4 / 10,000患者-年）相比，SIR为1.7（95%置信区间，0.5-7.1）。抗肿瘤坏死因子药物与免疫调节剂的使用与成人CD患者NHL风险增加相关，但这些事件的绝对发生率仍然很低，应该与治疗相关的实质性益处进行权衡。
Although anti–tumor necrosis factor (TNF) therapy can effectively treat Crohn's disease (CD), there is concern that it might increase the risk of non-Hodgkin's lymphoma (NHL). A meta-analysis was performed to determine the rate of NHL in adult CD patients who have received anti-TNF therapy and to compare this rate with that of a population-based registry and a population of CD patients treated with immunomodulators. MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science were searched. Inclusion criteria included randomized controlled trials, cohort studies, or case series reporting on anti-TNF therapy in adult CD patients. Standardized incidence ratios (SIR) were calculated by comparing the pooled rate of NHL with the expected rate of NHL derived from the Surveillance Epidemiology & End Results (SEER) database and a meta-analysis of CD patients treated with immunomodulators. Twenty-six studies involving 8905 patients and 21,178 patient-years of follow-up were included. Among anti-TNF treated subjects, 13 cases of NHL were reported (6.1 per 10,000 patient-years). The majority of these patients had previous immuno-modulator exposure. Compared with the expected rate of NHL in the SEER database (1.9 per 10,000 patient-years), anti-TNF treated subjects had a significantly elevated risk (SIR, 3.23; 95% confidence interval, 1.5–6.9). When compared with the NHL rate in CD patients treated with immunomodulators alone (4 per 10,000 patient-years), the SIR was 1.7 (95% confidence interval, 0.5–7.1). The use of anti-TNF agents with immunomodulators is associated with an increased risk of NHL in adult CD patients, but the absolute rate of these events remains low and should be weighed against the substantial benefits associated with treatment.
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DOI：
10.1111/j.1539-6924.2008.01135.x
发表时间：
2009-01
期刊：
Risk analysis : an official publication of the Society for Risk Analysis
影响因子：
--
作者：
Johnson FR;Ozdemir S;Mansfield C;Hass S;Siegel CA;Sands BE
通讯作者：
Sands BE
影响因子：
29.4
作者：
Lewis, JD;Bilker, WB;Strom, BL
通讯作者：
Strom, BL
影响因子：
24.5
作者：
Biancone, L;Orlando, A;Pallone, F
通讯作者：
Pallone, F
影响因子：
12.6
作者：
Kappelman, Michael D.;Rifas-Shiman, Sheryl L.;Finkelstein, Jonathan A.
通讯作者：
Finkelstein, Jonathan A.
影响因子：
4.9
作者：
Ardizzone, S;Maconi, G;Porro, GB
通讯作者：
Porro, GB