Siegel Corey A, Marden Sadie M, Persing Sarah M, Larson Robin J, Sands Bruce E
Dartmouth-Hitchcock IBD Center and Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, Massachusetts, USA.
Clin Gastroenterol Hepatol. 2009 Aug;7(8):874-81. doi: 10.1016/j.cgh.2009.01.004. Epub 2009 Jan 24.
BACKGROUND & AIMS: 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 immunomodulator 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.
尽管抗肿瘤坏死因子（TNF）疗法可有效治疗克罗恩病（CD），但人们担心其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患者中NHL的发生率，并将该发生率与基于人群的登记数据以及接受免疫调节剂治疗的CD患者群体的发生率进行比较。
检索了MEDLINE、EMBASE、Cochrane协作网和科学引文索引数据库。纳入标准包括关于成年CD患者抗TNF治疗的随机对照试验、队列研究或病例系列。通过将NHL的汇总发生率与来自监测、流行病学与最终结果（SEER）数据库的NHL预期发生率以及对接受免疫调节剂治疗的CD患者进行的荟萃分析得出的预期发生率进行比较，计算标准化发病比（SIR）。
纳入了26项研究，涉及8905例患者，随访时间共计21178患者年。在接受抗TNF治疗的受试者中，报告了13例NHL（每10000患者年6.1例）。这些患者中的大多数曾接触过免疫调节剂。与SEER数据库中NHL的预期发生率（每10000患者年1.9例）相比，接受抗TNF治疗的受试者风险显著升高（SIR，3.23；95%置信区间，1.5 - 6.9）。与仅接受免疫调节剂治疗的CD患者的NHL发生率（每10000患者年4例）相比，SIR为1.7（95%置信区间，0.5 - 7.1）。
在成年CD患者中，抗TNF药物与免疫调节剂联合使用会增加NHL风险，但这些事件的绝对发生率仍然较低，应与治疗带来的显著益处相权衡。
