Applying the Evidence: A Critical Appraisal of the Safety of TNF Blockers in RA

Faculty

Needs Statement

Currently, three tumor necrosis factor (TNF) antagonists are approved for the treatment of patients with rheumatoid arthritis (RA): infliximab, etanercept, and adalimumab. Whilst, overall, TNF antagonists are well tolerated and have demonstrated a favorable risk–benefit profile, there are lingering concerns over their long-term safety. For example, data from clinical trials and long-term postmarketing surveillance suggest that RA patients receiving TNF antagonists may be at increased risk for opportunistic infections, malignancy and lymphoma, congestive heart failure, injection/infusion reactions, development of autoantibodies, and lupus-like disease.

Applying the Evidence: A Critical Appraisal of the Safety of TNF Antagonists in Rheumatoid Arthritis is a Continuing Medical Education (CME)-accredited educational program that presents a carefully constructed literature review of available published data. The monograph has been developed to equip readers with practical knowledge of the area under discussion.

Target Audience

This activity is designed to meet the educational needs of practicing rheumatologists and allied healthcare professionals involved in the management and treatment of patients with rheumatoid disease.

Objectives

Upon completion of this activity, participants should be able to:
1. Appreciate some of the limitations inherent in the evaluation of safety issues regarding TNF antagonists in the treatment of RA;
2. Understand the available data regarding the incidence of serious infections, tuberculosis, opportunistic infections, and other infection possibilities, such as postoperative infections and hepatitis, as well as immunization issues in RA patients treated with TNF antagonists;
3. Differentiate between the risk of lymphoma in RA patients and the risk in RA patients treated with TNF antagonists, and also determine whether or not there is an increased risk of solid tumors other than lymphoma in RA patients treated with TNF antagonists;
4. Comprehend the potential change in cardiovascular risk in RA patients treated with TNF antagonists, and appreciate several other possible safety concerns including multiple sclerosis and demyelinating diseases, induction of autoantibodies and autoimmune diseases, liver function abnormalities, and pregnancy.

Accreditation

Medicine
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and Remedica Medical Education. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 2.00 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Faculty Disclosure

Dr. Cohen discloses relevant financial relationships with Abbott, Amgen, Centocor, Genetech and Wyeth.

Dr. Hobbs discloses relevant financial relationships with Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genentech and Wyeth.

Dr. Schiff discloses relevant financial relationships with Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genentech, Roche, Targeted Genetics, UCB and Wyeth-Ayerst.

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and Remedica Medical Education. Supported by an unrestricted educational grant from Abbott Laboratories.