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To the Editor: We have a number of concerns about the meta-analysis of anti-TNF antibody therapies in RA and the risk of serious infections and malignancies by Dr Bongartz and colleagues.¹ First, the pharmacological justification for excluding etanercept from the meta-analysis was not germane to actual clinical experience with anti-TNF agents. To further substantiate the results of the meta-analysis, the authors also cited a study in which patients receiving etanercept showed an increased number of solid malignancies.² Etanercept is widely prescribed for patients with RA, and we believe that data for etanercept should have been included in the meta-analysis.

Second, the meta-analysis used clinical trial data in which the labeled infliximab induction dose (3 mg/kg at weeks 0, 2, and 6) for RA was exceeded in approximately 50% of the patients randomized to receive infliximab. Since 59% of serious infections and 92% of malignancies occurred in patients receiving unapproved induction . . . [Full Text of this Article]

Peter E. Callegari, MD
PCallega@cntus.jnj.com

Thomas F. Schaible, PhD
Centocor Inc
Horsham, Pa

Jerome A. Boscia, MD
Centocor Research and Development Inc
Malvern, Pa