INFO - Risk and prevention of TB and other serious opportunistic infections associated with the inhibition of TNF

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Medscape Rheumatology

Posted 15 Nov 2006

L Winthrop

" Risk and Prevention of Tuberculosis and Other Serious Opportunistic

Infections Associated with the Inhibition of Tumor Necrosis Factor " :

Summary and Introduction

Summary

Tumor necrosis factor (TNF) is a proinflammatory cytokine that has a

key role in the pathogenesis of a variety of autoimmune

diseases—including rheumatoid arthritis—and is an important

constituent of the human immune response to infection. At present,

three anti-TNF agents are approved (in the US and elsewhere) to treat

selected autoimmune diseases: infliximab, etanercept, and adalimumab.

These biologic agents have been associated with a variety of serious

and 'routine' opportunistic infections; however, differences exist in

the mechanisms of action of these agents that might confer variation

in their associated risks of infection. From a public-health

standpoint, the development of active tuberculosis in some patients

who receive anti-TNF therapy is a matter of serious concern.

Tuberculosis in such patients frequently presents as extrapulmonary or

disseminated disease, and clinicians should be vigilant for

tuberculosis in any patient taking anti-TNF therapy who develops

fever, weight loss, or cough. To prevent the reactivation of latent

tuberculosis infection during anti-TNF therapy, clinicians should

screen all patients for tuberculosis, and begin treatment if latent

infection is found, before anti-TNF therapy is initiated. Specific

tuberculosis screening and treatment strategies vary between

geographical regions and are reviewed in this document. The screening

strategies employed in Europe and North America have reduced the

occurrence of anti-TNF-associated tuberculosis and are clearly to be

recommended, but the role of screening in the prevention of other

opportunistic (e.g. fungal) infections is far less certain.

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Read the entire article here:

http://www.medscape.com/viewarticle/546951_1

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