SynthesisBMJ open2017
Risk of tuberculosis in patients treated with TNF-α antagonists: a systematic review and meta-analysis of randomised controlled trials.
Synthesis in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 92 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
92 citing papers in PubMed, 5 syntheses or guidelines pooled it, 177 citations in OpenAlex.
- S3 Guideline for the Treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - part 2: Specific clinical and comorbid situations.Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG · 2026Guideline
- Comparative risk of tuberculosis infection with different TNF-α inhibitors in immune-mediated inflammatory diseases: a systematic review and network meta-analysis.Frontiers in immunology · 2026Pooled it
- Safety of Interleukin Inhibitors in Psoriatic Patients with Latent Tuberculosis Infection Without Chemoprophylaxis: A Systematic Review.Acta dermato-venereologica · 2025Pooled it
- Regional risk ofFrontiers in pharmacology · 2023Pooled it
- Incidence of tuberculosis in patients receiving anti-TNF therapy for rheumatic diseases: a systematic review.Clinical rheumatology · 2020Pooled it
- Pharmacokinetics, safety, and immunogenicity of HLX03, an adalimumab biosimilar, compared with reference biologic in healthy Chinese male volunteers: Results of a randomized, double-blind, parallel-controlled, phase 1 study.Pharmacology research & perspectives · 2021Trial
- Styrene Maleic Acid Lipid Particles Prepared from Mycobacterium tuberculosis Plasma Membrane can Potentially Induce Innate and Adaptive Immune Responses in Healthy Individuals of a Tuberculosis Hyperendemic Region.Current microbiology · 2026Article
- Cerebrospinal fluid transcriptional immune pathways linked to survival in HIV-associated tuberculous meningitis.The Journal of infectious diseases · 2026Article
- Inconsistent standard of care for tuberculosis screening and preventive therapy before initiating systemic psoriasis treatment.Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG · 2026Article
- [Biologics and infections: understand and recognize].Dermatologie (Heidelberg, Germany) · 2026Review
- Beyond the Flare: A Case of Disseminated Tuberculosis and Thrombosis Masquerading as IBD Exacerbation.Clinical journal of gastroenterology · 2026Article
- Efficacy and Safety of Tildrakizumab in Elderly Patients With Psoriasis: A Narrative Review.The Journal of clinical and aesthetic dermatology · 2026Review
- Fourth-generation chemiluminescence QuantiFERON-TB Plus assayERJ open research · 2026Article
- Series 3: From Infection to Disease: A Global Scoping Review of Medical and Behavioural Determinants of Progression from TB Infection to TB Disease.Tropical medicine and infectious disease · 2026Review
- Context-specific roles for IL-17 in tuberculosis.PLoS pathogens · 2026Review
- Promising TNF-α inhibitors: Targeting pathogenic TNF-α/TNFR signaling to restore Th17/Treg balance in rheumatoid arthritis.Journal of pharmaceutical analysis · 2026Review
- Drug Stratification Based on Real-World Evidence in Psoriasis: A Narrative Review.Dermatology and therapy · 2026Review
- The Role of TNF-α in Ischemic Stroke.International journal of molecular sciences · 2026Review
- Pneumococcal Endopeptidase O Attenuates Colitis by Inhibiting the Macrophage-CCL2 Axis and Reshaping Gut Microbiota.Journal of inflammation research · 2026Article
- Tuberculosis incidence in patients treated with secukinumab - a real-world study in Brazil.Advances in rheumatology (London, England) · 2025Article
32 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAn increased risk of tuberculosis (TB) has been reported in patients treated with TNF-α antagonists, an issue that has been highlighted in a WHO black box warning. This review aimed to assess the risk of TB in patients undergoing TNF-α antagonists treatment.
methodsA systematic literature search for randomised controlled trials (RCTs) was performed in MEDLINE, Embase and Cochrane library and studies selected for inclusion according to predefined criteria. ORs with 95% CIs were calculated using the random-effect model. Subgroup analyses considered the effects of drug type, disease and TB endemicity. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
results29 RCTs involving 11 879 patients were included (14 for infliximab, 9 for adalimumab, 2 for golimumab, 1 for etanercept and 3 for certolizumab pegol). Of 7912 patients allocated to TNF-α antagonists, 45 (0.57%) developed TB, while only 3 cases occurred in 3967 patients allocated to control groups, resulting in an OR of 1.94 (95% CI 1.10 to 3.44, p=0.02). Subgroup analyses indicated that patients of rheumatoid arthritis (RA) had a higher increased risk of TB when treated with TNF-α antagonists (OR 2.29 (1.09 to 4.78), p=0.03). The level of the evidence was recommended as 'low' by the GRADE system.
conclusionsFindings from our meta-analysis indicate that the risk of TB may be significantly increased in patients treated with TNF-α antagonists. However, further studies are needed to reveal the biological mechanism of the increased TB risk caused by TNF-α antagonists treatment.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.