Safety of anti-TNF agents in patients with compensated cirrhosis: a case-control study.
| Autor: | Kapila N; Department of Transplant, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA., Gonzalez A; Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA., Rosado JM; Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA., Flocco G; Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA., Salomon F; Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA., Abusaif M; Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA., Hussain I; Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA., Moor MA; Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA., Modaresi-Esfeh J; Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA., Castro FJ; Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Therapeutic advances in gastroenterology [Therap Adv Gastroenterol] 2021 Oct 22; Vol. 14, pp. 17562848211037094. Date of Electronic Publication: 2021 Oct 22 (Print Publication: 2021). |
| DOI: | 10.1177/17562848211037094 |
| Abstrakt: | Background: There is limited data on the use of anti-TNF agents in patients with concomitant cirrhosis. The aim of this study is to assess the safety of anti-TNF agents in patients with compensated cirrhosis who used these medications for the treatment of an underlying rheumatologic condition or IBD. Methods: Multicenter, retrospective, matched, case-control study. A one to three case-control match was performed. Adults who received anti-TNF therapy were matched to three adults with cirrhosis who did not receive anti-TNF therapy. Patients were matched for etiology of cirrhosis, MELD-Na and age. Primary outcome was the development of hepatic decompensation. Secondary outcomes included development of infectious complications, hepatocellular carcinoma (HCC), extra-hepatic malignancy, and mortality. Results: Eighty patients with cirrhosis who received anti-TNF agents were matched with 240 controls. Median age was 57.2 years. Median MELD-Na for the anti-TNF cohort was seven and median MELD-Na for the controls was eight. The most common etiology of cirrhosis was NAFLD. Anti-TNF therapy did not increase risk of decompensation (HR: 0.91, 95% CI: 0.64-1.30, p = 0.61) nor influence the time to development of a decompensating event. Anti-TNF therapy did not increase the risk of hepatic mortality or need for liver transplantation (HR: 1.18, 95% CI: 0.55-2.53, p = 0.67). Anti-TNF therapy was not associated with an increased risk of serious infection (HR: 1.21, 95% CI: 0.68-2.17, p = 0.52), HCC (OR: 0.45, 95% CI: 0.13-1.57, p = 0.21), or extra-hepatic malignancy (OR: 0.82, 95% CI: 0.29-2.30, p = 0.71). Conclusions: Anti-TNF agents in patients with compensated cirrhosis does not influence the risk of decompensation, serious infections, transplant free survival, or malignancy. Competing Interests: Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© The Author(s), 2021.) |
| Databáze: | MEDLINE |
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