Clinical use of anti-TNF therapy and increased risk of infections

Abstract

Biologics such as antitumor necrosis factor (anti-TNF) drugs have emerged as important agents in the treatment of many chronic inflammatory diseases, especially in cases refractory to conventional treatment modalities. However, opportunistic infections have become a major safety concern in patients on anti-TNF therapy, and physicians who utilize these agents must understand the increased risks of infection. A literature review of the published data on the risk of bacterial, viral, fungal, and parasitic infections associated with anti-TNF therapy was performed and the clinical presentation, diagnostic tests, management, and prevention of opportunistic infections in patients receiving anti-TNF therapy were reviewed. Awareness of the therapeutic potential and associated adverse events is necessary for maximizing therapeutic benefits while minimizing adverse effects from anti-TNF treatments. Patients should be adequately vaccinated when possible and closely monitored for early signs of infection. When serious infections occur, withdrawal of anti-TNF therapy may be necessary until the infection has been identified and properly treated.

RP105 Engages Phosphatidylinositol 3-Kinase p110δ To Facilitate the Trafficking and Secretion of Cytokines in Macrophages during Mycobacterial Infection

“…In conjunction with IFN-g, TNF enhances the production of reactive radicals and the antimycobacterial activity of macrophages (51). Data from patients receiving TNF-neutralizing therapies as well as mouse studies demonstrate that effective TNF signaling is required for granuloma formation and maintenance during active as well as latent tuberculosis (52). TNF expression by macrophages in responses to mycobacteria is known to occur downstream of TLRs and c-type lectin receptors via the activation of NF-kB and MAPK signaling, and is regulated by microRNAs and SHIP (4,8,53).…”

In vivo effect of anti-TNF agent (etanercept) in reactivation of latent toxoplasmosis

“…However, if the balance between the host immune defenses and the parasite is disrupted, cyst rupture and renewed parasite proliferation may occur leading to clinical reactivation. Reactivation of toxoplasmosis was found to be a serious complication in patients receiving anti-TNF therapy (Ali et al 2013).…”

Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

“…21,22 TNF-α plays a crucial role in the maintenance of granulomas and immune responses against viral or intracellular bacterial pathogens; therefore, its inhibition can potentially lead to an increased risk of infections, such as reactivation of latent tuberculosis, hepatitis B, and varicella zoster virus infection. 23 According to a pooled analysis of five pivotal studies (ACCENT I, ACCENT II, SONIC, ACT 1, and ACT 2), 22 infections were found in 846 (49.4%) patients of the infliximab group and in 162 patients (39.9%) of the placebo group (P < 0.001), with symptoms of abscess, bacterial infection, gastroenteritis, and pneumonia. The number of patients experiencing at least one serious infection in the infliximab group was not significantly higher than that of the placebo group (P = 0.427).…”