Comparing the lifetime risks of TNF-alpha inhibitor use to common benchmarks of risk.
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OBJECTIVE: The study aims to illustrate the range of lifetime risks of lymphoma, tuberculosis (TB), and demyelinating diseases with TNF- inhibitors in psoriasis patients. METHODS: Previously published data and online resources were used to determine the risk of the TB, demyelinating disease, and lymphoma with and without TNF- inhibitor treatment. Lifetime risks for heart disease and stroke were collected using a Medline search. All cancer, trauma, and environmental statistics were obtained from the data published by National Cancer Institute, National Safety Council, and the National Oceanic and Atmospheric Administration, respectively. RESULTS: The lifetime risks of TNF--inhibitor-linked conditions and comparators are as follows: TNF- inhibitor-linked conditions: lymphoma with: without TNF- inhibitors (0.5-4.8%:2.3%), TB with:without TNF- inhibitors (0-17.1%:0.3%), and demyelinating disease with:without TNF- inhibitors (0.1-1.7%:0.15%). Comparators: cancer (40.4%), heart disease (36.2%), stroke (18.4%), accidental death (3.0%), motor vehicle death (1.2%), and lightning strike (0.033%). LIMITATIONS: Much of the data on lifetime risks of disease with TNF- inhibitor were for patients with rheumatoid arthritis and not psoriasis. CONCLUSIONS: The risks of lymphoma, demyelinating diseases, and tuberculosis with TNF- inhibitors are lower than risks patients face on a regular basis. Screening reduces the risk of tuberculosis in patients receiving TNF- inhibitors.
