RESEARCH - Drug-specific risk of non-TB opportunistic infections: RATIO

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Ann Rheum Dis. 2010 Dec 21. [Epub ahead of print]

Drug-specific risk of non-tuberculosis opportunistic infections in

patients receiving anti-TNF therapy reported to the 3-year prospective

French RATIO registry.

Salmon-Ceron D, Tubach F, Lortholary O, Chosidow O, Bretagne S,

Nicolas N, Cuillerier E, Fautrel B, Michelet C, Morel J, Puéchal X,

Wendling D, Lemann M, Ravaud P, Mariette X; for the RATIO group.

1Université Paris Descartes Assistance Publique-Hôpitaux de Paris

(AP-HP), Hôpital Cochin Broca Hôtel Dieu, Unité de Maladies

Infectieuses, Pôle de médecine, Paris, France.

Abstract

BACKGROUND: Anti-tumour necrosis factor (TNF) therapy may be

associated with opportunistic infections (OIs).

OBJECTIVE: To describe the spectrum of non-tuberculosis OIs associated

with anti-TNF therapy and identify their risk factors.

METHODS: A 3-year national French registry (RATIO) collected all cases

of OI in patients receiving anti-TNF treatment for any indication in

France. A case-control study was performed with three controls treated

with anti-TNF agents per case, matched for gender and underlying

inflammatory disease.

RESULTS: 45 cases were collected of non-TB OIs in 43 patients

receiving infliximab (n=29), adalimumab (n=10) or etanercept (n=4) for

rheumatoid arthritis (n=26), spondyloarthritides (n=3), inflammatory

colitis (n=8), psoriasis (n=1) or other conditions (n=5). One-third

(33%) of OIs were bacterial (4 listeriosis, 4 nocardiosis, 4 atypical

mycobacteriosis, 3 non-typhoid salmonellosis), 40% were viral (8

severe herpes zoster, 3 varicella, 3 extensive herpes simplex, 4

disseminated cytomegalovirus infections), 22% were fungal (5

pneumocystosis, 3 invasive aspergillosis, 2 cryptococcosis) and 4%

were parasitic (2 leishmaniasis). Ten patients (23%) required

admission to the intensive care unit, and four patients (9%) died.

Risk factors for OIs were treatment with infliximab (OR=17.6 (95% CI

4.3 - 72.9); p<0.0001)or adalimumab (OR=10.0 (2.3 to 44.4); p=0.002)

versus etanercept, and oral steroid use >10 mg/day or intravenous

boluses during the previous year (OR=6.3 (2.0 to 20.0); p=0.002).

CONCLUSION: Various and severe OIs, especially those with

intracellular micro-organisms, may develop in patients receiving

anti-TNF treatment. Monoclonal anti-TNF antibody rather than soluble

TNF receptor therapy and steroid use >10 mg/day are independently

associated with OI.

PMID: 21177290

http://www.ncbi.nlm.nih.gov/pubmed/21177290

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