Evidence map›Paper›PMID 42426413›Full record

SynthesisEuropean journal of clinical pharmacology2026

Infection risks associated with b/tsDMARDs in rheumatoid arthritis: a systematic review and network meta-analysis.

Xue-Mei Zhang, Li Liu, Yi-Dan Yan, Zai-Li Zhang, Ke-Jia Le, Yang-Xi Liu, Xiao-Jun Ni, Liang-Jing Lu, Guo-Hua Zhou, Zhi-Chun Gu and 2 more

Abstract readNetwork Meta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Xue-Mei Zhang *Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.ORCID https://orcid.org/0009-0000-4897-1103
Li Liu *Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
Yi-Dan YanDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
Zai-Li ZhangDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
Ke-Jia LeDepartment of Pharmacy, Jiangwan Hospital of Hongkou District, Shanghai, 200081, China.
Yang-Xi LiuDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
Xiao-Jun NiDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
Liang-Jing LuDepartment of Rheumatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
Guo-Hua ZhouDepartment of Clinical Pharmacy, State Key Laboratory of Analytical Chemistry for Life Science and Jiangsu Key Laboratory of Molecular Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China.
Zhi-Chun GuDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China. guzhichun213@163.com.
Jia LiDepartment of Rheumatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China. leejiasjtu@163.com.
Hou-Wen LinDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China. franklin67@126.com.

Funding

National Natural Science Foundation of China 22137006Renji Infection Control Program RJIPC2025003"Scientific Benchmarking Management of Antimicrobial Drugs" Project established by Clinical Pharmacy Management Professional Committee of Shanghai Hospital Association 2023LCYS001_S08Shanghai Hospital Development Center Foundation SHDC12024630Shanghai "Rising Stars of Medical Talents" Youth Development Program JLShanghai Science and Technology Program Project 25SF1901300, 25SF1901301Shanghai Young Pharmaceutical Talents Capacity Building Program SPAQNRC2025A07the Academic leader training program of Pudong New Area Health Commission PWRd2023-02the Clinical Research Innovation and Cultivation Fund of Ren Ji hospital PY2018-III-04the Talent Project established by Chinese Pharmaceutical Association Hospital Pharmacy department CPA-Z05-ZC-2023-003Youth Research Promotion Program of Ren Ji Hospital RJTJ25-QN-122
6 · The paper itself

Abstract

objectivesTo evaluate infection risks in rheumatoid arthritis (RA) patients with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) as monotherapy or combined with conventional synthetic DMARDs (csDMARDs).

methodsA comprehensive literature search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from their inception to 31 October 2024 was conducted to identify randomized controlled trials (RCTs) assessing infection risks in RA patients receiving b/tsDMARDs. Primary outcome was serious infection incidence; secondary outcomes included any infection and specific events such as respiratory tract infections, gastroenteritis and herpes zoster. A frequentist network meta-analysis was performed to calculate odds ratios (ORs).

resultsA total of 127 RCTs involving 55,749 patients were included. b/tsDMARD monotherapy showed a similar risk of serious infections versus csDMARDs. Combining csDMARDs with adalimumab, infliximab, tofacitinib, or upadacitinib (though not with other b/tsDMARDs) was associated with a significantly increased risk of serious infections (OR 1.51, 95% CI: 1.04-2.19; OR 1.75, 95% CI: 1.09-2.81; OR 2.52, 95% CI: 1.26-5.03; OR 2.31, 95% CI: 1.13-4.73). For any infection, b/tsDMARD monotherapy posed a similar risk to csDMARDs, except for etanercept. Certain tsDMARDs were associated with an increased incidence of herpes zoster versus csDMARDs, except for filgotinib and peficitinib.

conclusionCompared to csDMARDs, b/tsDMARD monotherapy showed no elevated serious infection risk, whereas specific combinations increased the risk of serious infections in RA patients. A clinical reference pathway was developed to inform drug selection optimization for RA patients receiving b/tsDMARDs.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidInfectionsHumansRandomized Controlled Trials as TopicAntirheumatic AgentsDMARDsInfectionNetwork meta-analysisRheumatoid arthritis

Identifiers

PMID42426413

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.