The Risk of Tuberculosis in Patients with Rheumatoid Arthritis Treated with Infliximab as Compared to Etanercept: Systematic Review and Metanalysis

Introduction: Tumor Necrosis Factor-alpha (TNF-α) inhibitors may predispose patients to tuberculosis (TB) infection during the treatment of rheumatoid arthritis (RA). This systematic review analyzes the risk of tuberculosis in RA patients treated with anti-TNF-α antibodies, infliximab compared to etanercept. Methods: A systematic review was conducted using the PubMed, Cochrane, and Embase databases to identify relevant data between 2015 and 2022. Pooled effect estimates of log Risk Ratios were analyzed, bias analysis was conducted, and the potential effects of screening and prophylaxis were reviewed. Results: 37 studies identified were screened, and only observational studies met the inclusion criteria. Both infliximab and etanercept patients show the same risk ratio to develop tuberculosis. Bias analysis was performed, and two of four studies showed a moderate risk of bias. Screening and prevention for latent TB infection (LTBI) did not decrease the risk of TB reactivation in two of the three studies referring to these data. Discussion: Infliximab does not pose a higher risk of developing TB than etanercept use in patients with RA. LTBI screening and prophylaxis alone may be insufficient preventive steps for TB development in these patients. Further research in this field is warranted to reduce TB risk, particularly in countries with a high incidence of TB.