Atzeni Fabiola, Nucera Valeria, Gerratana Elisabetta, Cirillo Mariateresa, Marino Francesca, Miceli Gianfranco, Sangari Donatella, Boccassini Laura, Masala Ignazio Francesco
Rheumatology Unit, University of Messina , Messina, Italy.
Department of Rheumatology, ASST Fatebenefratelli-Sacco , Milan, Italy.
Expert Opin Drug Saf. 2020 Jun;19(6):695-705. doi: 10.1080/14740338.2020.1763299. Epub 2020 May 13.
More than 15 years after its introduction, there is still no agreement as to whether anti-TNF treatment increases the risk of developing infections, cardiovascular or neurological diseases, or auto-antibodies. Anti-TNF drugs reduce inflammation and sub-clinical atherosclerosis in rheumatoid arthritis (RA) patients, but they also alter their lipid profiles and can lead to the development of severe infections. Furthermore, as they increase the risk of developing demyelinating diseases, are not recommended in patients with multiple sclerosis or related disorders. The authors searched the Medline database for English language articles concerning the adverse events of anti-TNF drugs published between 1998 and December 2019, and have summarized their contents relating to infections, malignancies, cardiovascular diseases, autoimmunity and neurological diseases. Patients should be fully informed of the increased risks associated with anti-TNF drugs, and physicians should know how to treat them.
This review considers these safety concerns, their possible underlying causes, and other aspects that are important in clinical practice.
Growing concern about the safety of anti-TNF drugs underlines the need to ensure that all clinicians are capable of taking appropriate preventive and therapeutic action.
自抗 TNF 治疗问世 15 年多以来，对于其是否会增加感染、心血管疾病、神经系统疾病或自身抗体的发生风险，仍未达成共识。抗 TNF 药物可减轻类风湿性关节炎（RA）患者的炎症和亚临床动脉粥样硬化，但它们也会改变患者的血脂谱，并可能导致严重感染。此外，由于它们会增加脱髓鞘疾病的发生风险，因此不建议用于患有多发性硬化症或相关疾病的患者。作者检索了 Medline 数据库中 1998 年至 2019 年 12 月期间发表的有关抗 TNF 药物不良事件的英文文章，并总结了其中与感染、恶性肿瘤、心血管疾病、自身免疫和神经系统疾病相关的内容。应让患者充分了解与抗 TNF 药物相关的风险增加情况，医生应知道如何对其进行治疗。
本综述探讨了这些安全问题、其可能的潜在原因以及临床实践中其他重要方面。
对抗 TNF 药物安全性的日益关注凸显了确保所有临床医生有能力采取适当预防和治疗措施的必要性。
