Evidence map›Paper›PMID 41694362›Full record

SynthesisFrontiers in immunology2026

Comparative risk of tuberculosis infection with different TNF-α inhibitors in immune-mediated inflammatory diseases: a systematic review and network meta-analysis.

Xiuying Lv, Yuan Liu, Yan Li, Qi Zhang, Shiju Chen, Xiaomei Liu, Guixiu Shi, Yan Li

Abstract readNetwork Meta-AnalysisSystematic ReviewComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. The neuroimmune system and cognition.Nature immunology · 2026
    Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Xiuying LvDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Yuan LiuDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Yan LiDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Qi ZhangDepartment of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Shiju ChenDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Xiaomei LiuDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Guixiu ShiDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Yan LiDepartment of Rheumatology and Clinical Immunology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Tumor necrosis factor-α inhibitors (TNFi) are established to increase the risk of tuberculosis (TB). However, the comparative risk across different TNFi agents remains poorly defined due to a lack of head-to-head comparative studies. This network meta-analysis (NMA) aimed to evaluate and compare the risk of TB infection associated with various TNFi therapies in patients with immune-mediated inflammatory diseases (IMIDs) based on real-world, long-term cohort studies. Methods: We conducted a systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 30, 2025, for cohort studies reporting TB events in patients with IMIDs treated with TNFi. Study selection, data extraction, and risk of bias assessment were performed by three independent reviewers using the Newcastle-Ottawa Scale. A Bayesian arm-based NMA with random-effects models was used to estimate log risk ratio (logRR) and 95% credible intervals (CrIs) for TB infection across different TNFi agents compared with TNFi-naive. Results: A total of 19 cohort studies involving 396, 044 patients were included. Compared to TNFi-naive, infliximab (IFX) was associated with the highest risk of TB (logRR = 2.32, 95% CrI: 1.12-3.32), followed by adalimumab (ADA) (logRR = 1.72, 95% CI: 0.42-2.65) and etanercept (ETN) (logRR = 1.39, 95% CI: 0.33-2.42). Certolizumab pegol (CZP) was associated with the lowest risk among TNFi agents. Conclusion: TNFi treatment in patients with IMIDs is associated with a significantly increased risk of TB infection. Among the TNFi agents, IFX was associated with the highest risk, while ETN and CZP demonstrated lower risks. These findings can inform clinical decision-making, suggesting that ETN or CZP may be preferable in patients with high TB risk, while emphasizing that vigilant TB monitoring remains paramount regardless of the chosen agent. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022331674.

Indexed as

InflammationTuberculosisTumor Necrosis Factor-alphaTumor Necrosis Factor InhibitorsHumansInfliximabRisk FactorsInfliximabTumor Necrosis Factor-alphaTumor Necrosis Factor Inhibitorsimmune-mediated inflammatory diseasesnetwork meta-analysissystematic reviewTNF-α inhibitorstuberculosis

Identifiers

PMID41694362
PMCPMC12894354

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.