RESEARCH - Arterial and venous thromboembolic events during anti-TNF therapy

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Biomed Mater Eng. 2009;19(4-5):355-64.

Arterial and venous thromboembolic events during anti-TNF therapy: a

study of 85 spontaneous reports in the period 2000-2006.

Petitpain N, Gambier N, Wahl D, Chary-Valckenaere I, Loeuille D,

Gillet P; French Network of Pharmacovigilance Centers.

Regional Pharmacovigilance Center of Lorraine, , France.

Abstract

BACKGROUND: Systemic inflammation such as rheumatoid arthritis (RA)

and Crohn's disease (CD) may be responsible for vascular comorbidity.

TNF-alpha blockade was expected to lower these comorbidities but

several cases of arterial and venous thromboembolic events (TE) have

been reported.

OBJECTIVES: The aim of this work was to study retrospectively the main

characteristics of spontaneously notified TNF-alpha blockers related

TE over a 7-year period.

METHODS: TE related to infliximab, etanercept and adalimumab

spontaneously notified to the French adverse drug reporting system

database between January 2000 and December 2006 were analyzed.

Separate analysis of arterial TE and venous TE was performed. Risk

factors for each category of TE were assessed with consensual

criteria.

RESULTS: 85 TE were analyzed, representing 4.5% of all the

spontaneously notified adverse reactions of the 3 TNF-alpha blockers

in the database. 42 were arterial events and 43 were venous events.

The incidence was not significantly different between the 3 TNF-alpha

blockers. Mean delay of TE onset after treatment initiation was 10.6

months. It was significantly shorter for etanercept (6.1 months,

p=0.001) especially for venous TE (2.4 months). 16 among the 42

patients with arterial TE had 2 or more risk factors whereas 39 among

the 43 patients with venous TE had no RF or only one. Most of patients

(79/85) received concomitant systemic corticosteroids and/or

methotrexate and/or COX-2 selective inhibitors. 23 patients had been

investigated for autoimmunity, 13 had antinuclear and/or

antiphospholipid antibodies. Main limitations of this study were

underreporting and heterogeneous report contents.

CONCLUSION: Despite its limitations, this study suggests that venous

TE could be favoured by TNF-alpha blockers therapy since they occurred

in patients with no or few risk factors for venous thrombosis.

However, this needs to be more evaluated by controlled studies.

PMID: 20042802

http://www.ncbi.nlm.nih.gov/pubmed/20042802

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