Comparing the lifetime risks of TNF-alpha inhibitor use to common benchmarks of risk

Edi KaminskaDepartment of Dermatology, University of Chicago, 5841 S. Maryland Avenue, MC 5067, Chicago, IL, USA

Isha Patel Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan at Ann Arbor, 428 Church Street, Ann Arbor, MI, USA; Center for Medication Use, Policy, and Economics, The University of Michigan, 428 Church Street, Ann Arbor, MI, USA; Center of Global Health, The University of Michigan, 428 Church Street, Ann Arbor, MI, USACorrespondence[email protected]

Tushar S. DabadeDepartment of Dermatology, University of Chicago, 5841 S. Maryland Avenue, MC 5067, Chicago, IL, USA;Department of Dermatology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA

Jongwha Chang Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan at Ann Arbor, 428 Church Street, Ann Arbor, MI, USA; Center for Medication Use, Policy, and Economics, The University of Michigan, 428 Church Street, Ann Arbor, MI, USA; Center of Global Health, The University of Michigan, 428 Church Street, Ann Arbor, MI, USA

Ayub A. QureshiDepartment of Dermatology, University of Chicago, 5841 S. Maryland Avenue, MC 5067, Chicago, IL, USA;Department of Dermatology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA

Jenna L O'NeillDepartment of Dermatology, University of Chicago, 5841 S. Maryland Avenue, MC 5067, Chicago, IL, USA;Department of Dermatology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA

Rajesh Balkrishnan Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan at Ann Arbor, 428 Church Street, Ann Arbor, MI, USA; Center for Medication Use, Policy, and Economics, The University of Michigan, 428 Church Street, Ann Arbor, MI, USA; Center of Global Health, The University of Michigan, 428 Church Street, Ann Arbor, MI, USA;Department of Health Management and Policy, The University of Michigan, 428 Church Street, Ann Arbor, MI, USA

Steven R. FeldmanDepartment of Dermatology, University of Chicago, 5841 S. Maryland Avenue, MC 5067, Chicago, IL, USA;Department of Dermatology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA; Center for Worker Health, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA; Center for Integrative Medicine, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA;Department of Pathology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA;Department of Social Sciences & Health Policy, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA

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Abstract

Objective: The study aims to illustrate the range of lifetime risks of lymphoma, tuberculosis (TB), and demyelinating diseases with TNF-α 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-α 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-α-inhibitor-linked conditions and comparators are as follows: TNF-α inhibitor-linked conditions: lymphoma with: without TNF-α inhibitors (0.5–4.8%:2.3%), TB with:without TNF-α inhibitors (0–17.1%:0.3%), and demyelinating disease with:without TNF-α 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-α inhibitor were for patients with rheumatoid arthritis and not psoriasis. Conclusions: The risks of lymphoma, demyelinating diseases, and tuberculosis with TNF-α inhibitors are lower than risks patients face on a regular basis. Screening reduces the risk of tuberculosis in patients receiving TNF-α inhibitors.

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Declaration of interest: Dr. Feldman has served as an advisory board member, investigator, and speaker for Abbott Laboratories, Astellas, Galderma, Steifel, and Warner Chilcott, receiving grants and honoraria; has served on the advisory board for Photomedex, receiving stock options; has been an investigator and speaker for Amgen, Centocor, and Genentech, receiving grants and honoraria; and has served as an advisory board member and speaker for the National Psoriasis Foundation, receiving honoraria. Drs. Ntuen, Qureshi, O'Neill, Dabade, Balkrishnan, Ms. Patel, and Mr. Chang have no conflicts to report.

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