Safety of TNF-α inhibitors therapy in patients with rheumatoid arthritis: an umbrella review

作者：Rongchi Xiao, Peiyuan Tang, Jing Zhou, Weiyan Zheng, Yangbin Cao, Ying Zhu, Wenfeng Xiao, Han Tan, Ting‐Bin Wen, Ahmed Abdirahman, Yusheng Li · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103488 · 被引用次数：13 · 研究领域：Rheumatoid Arthritis Research and Therapies、Pharmacovigilance and Adverse Drug Reactions、Spondyloarthritis Studies and Treatments

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder that is characterized by progressive synovial inflammation and leads to joint destruction, functional decline, and reduced life expectancy. Although tumor necrosis factor-alpha inhibitors (TNFi) have revolutionized RA management by preventing structural damage, their safety profiles remain controversial. Current safety assessments remain fragmented across isolated meta-analyses, failing to address competing risks or incorporate recent pharmacovigilance data. This study compared the adverse effects of anti-TNF therapy in RA and provided a stratified safety profile for optimal treatment selection. Methods: The research team searched four databases, namely PubMed, Web of Science, EMBASE, and the Cochrane Library, for relevant articles published from January 2000 to March 2025. The review adhered rigorously to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. For each meta-analysis, we recalculated effect sizes as either odds ratio (OR), relative risk (RR) or standardized mean differences (SMD), accompanied by their respective 95% confidence intervals (CIs). Methodological quality of included meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), while the certainty of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. To address potential overlap among ...