Clinical Rheumatology

, Volume 32, Issue 3, pp 293–300 | Cite as

Safety of tumor necrosis factor inhibitors use for rheumatoid arthritis and ankylosing spondylitis in Africa, the Middle East, and Asia: focus on severe infections and tuberculosis

  • Mohammed HammoudehEmail author
  • Abdurhman Alarfaj
  • Der-Yuan Chen
  • Hachemi Djoudi
  • Ehab Youseif
  • Jian Zhu
Review Article


Multiple studies of patients in Western countries with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have indicated increased risk for active tuberculosis (TB) and other infections among these individuals. It has also been consistently reported that patients receiving tumor necrosis factor (TNF) inhibitors for these conditions have higher rates of active TB and other infections than RA or AS patients not receiving these medications. These issues have been studied less extensively in the Asia and Africa–Middle East regions, and information from these regions is important because of higher rates of TB in the general population. This paper reviews studies of RA and AS patients from Asia, Africa, and the Middle East who received TNF inhibitors. A literature search was conducted using to collect and report these data. The years included in the PubMed literature search ranged from January 2000 to October 2011. Additionally, information from the China Hospital Knowledge Database was used to report data from Chinese patients with RA and AS treated with TNF inhibitors. Results from these studies indicate that the risk for active TB and other infections in AS and RA patients from Asia, Africa, and the Middle East are increased in patients receiving TNF inhibitors and that the risk is higher among those treated with monoclonal antibodies versus soluble TNF receptor.


Adalimumab Ankylosing spondylitis Etanercept Infliximab Rheumatoid Tuberculosis 



Editorial/medical writing support was provided by WC Hatch at ACUMED and was funded by Pfizer Inc. No financial support was provided to the authors for this work.


Abdurhman Alarfaj has consulted and received honorarium from Pfizer Inc. Mohammed Hammoudeh has consulted for Schering-Plough Corp and consulted and received honoraria from Abbott Laboratories, Pfizer Inc, Roche Pharmaceuticals, and Wyeth Pharmaceuticals. He has received grant/research support from Pfizer Inc, Roche Pharmaceuticals, Schering-Plough Corp, and Wyeth Pharmaceuticals. Ehab Youseif is a Senior Regional Director, Medical Affairs for Pfizer Latin America. Der-Yuan Chen, Hachemi Djoudi, and Jian Zhu declare no conflicts of interest.


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Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Mohammed Hammoudeh
    • 1
    • 8
    Email author
  • Abdurhman Alarfaj
    • 2
  • Der-Yuan Chen
    • 3
    • 4
  • Hachemi Djoudi
    • 5
  • Ehab Youseif
    • 6
  • Jian Zhu
    • 7
  1. 1.Hamad Medical CorporationDohaQatar
  2. 2.Department of Medicine, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
  3. 3.Faculty of MedicineNational Yang Ming UniversityTaipeiTaiwan
  4. 4.Division of Allergy, Immunology and RheumatologyTaichung Veterans General HospitalTaichung CityTaiwan
  5. 5.Rheumatology DepartmentEHS DouéraAlgiersAlgeria
  6. 6.Pfizer IncCollegevilleUSA
  7. 7.Chinese PLA General HospitalBeijingChina
  8. 8.Division of Rheumatology, Department of MedicineHamad Medical CorporationDohaQatar

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