TNF-Alpha Inhibitors and Rhinosinusitis-A Systematic Review and Meta-Analysis.

Abstract

Background Tumor necrosis factor alpha (TNFα) plays key role in immunologic process. Patients receiving anti-TNFα therapy may likely be more predisposed to infections including sinus disorders. Objectives Our aims were to review literature and evaluate data regarding TNFα antagonist therapy and its association with reference to various sinus disorders in the form of a systematic review and meta-analysis. Methods Different keyword combinations were used in the screening of the literature including leading scientific databases (PubMed, Embase, and Web of Science). Papers reporting sinus disorders as supposed adverse events of the treatment were included into the meta-analysis. Results A thorough review of literature searches extracted 1154 records and 8 articles were found through other sources. Seventeen papers fulfilled our criteria for inclusion into the meta-analysis. Among 16 174 observed patients, 3018 suffered from a sinus infection. An event rate (ER) of 0.058 was calculated for all the cases. Analysis with regard to the confirmed diseases showed an 0.038 ER. Calculations were performed in accordance to the diagnostic categories used for sinus disorder. Six groups were found including the following: “Bacterial Sinusitis” (ER: 0.046), “Chronic Rhinosinusitis” (ER: 0.027), “Sinusitis Requiring Prescription Medication” (ER: 0.295), “Recurrent Sinusitis” (ER: 0.070), “Sinusitis” (ER: 0.076), “Acute Rhinosinusitis” (ER: 0.002) and, lastly, “Maxillary Sinusitis” (ER: 0.028). Conclusions Our results exhibited a similar prevalence to the healthy population; therefore, infective sinus disorders cannot directly be considered as complications of TNFα antagonist therapy.