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To the Editor: In their meta-analysis, Dr Bongartz and colleagues¹ assessed the risks of infections and malignancies associated with the use of tumor necrosis factor (TNF-) antibody therapies in randomized controlled trials of patients with rheumatoid arthritis (RA). Because each original study had few events, answering this question requires pooling the findings of many trials, each of which has limited power to examine adverse event rates.

The authors did not include the results of the PREMIER trial because at the time of their meta-analysis it was only in abstract form and the data were apparently unavailable. However, this 2-year trial with 799 participants has subsequently been published.² We used exactly the same methods described by Bongartz et al, adding the adverse events of the PREMIER trial, and found that it decreased the pooled odds ratio (OR) for malignancy from 3.29 (95% confidence interval [CI], 1.19-9.08) to 2.02 (95% CI, . . . [Full Text of this Article]

Karen H. Costenbader, MD, MPH
KCostenbader@partners.org

Roberta Glass, MS; Jing Cui, MD, PhD; Nancy Shadick, MD, MPH
Division of Rheumatology, Immunology and Allergy
Brigham and Women's Hospital
Boston, Mass

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