Effect of tumor necrosis factor-α antagonism in asthma: a meta-analysis of the published literature.

It remains controversial whether tumor necrosis factor (TNF)-α antagonism is effective for asthma. This meta-analysis was performed to evaluate efficacy of TNF-α antagonism in treatment of patients with asthma. MEDLINE, EMBASE, LILACS, and CINAHL databases were searched for English-language studies published through January 3, 2010. Randomized-controlled trials comparing TNF-α antagonism with control therapy were selected. For each report, data were extracted in relation to the outcomes analyzed: asthma exacerbation, asthma quality of life questionnaire scores, and forced expiratory volume in 1 second. Four assessable trials were identified including 641 patients with asthma. TNF-α antagonism therapy was superior to control therapy in preventing exacerbations in asthmatics [pooled odds ratio 0.52 (95% confidence interval 0.29-0.88), P=0.02]; however, there was a nonsignificant reduction in asthma quality of life questionnaire scores [0.23 (0 to 0.47), P=0.05], forced expiratory volume in 1 second [0.03, (-0.14 to 0.10), P=0.74] when analyzed using standardized mean differences. TNF-α antagonism was superior to control chemotherapy in terms of asthma exacerbation, but not asthma quality of life questionnaire scores or forced expiratory volume in 1 second.