Drug-specific risk of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry

Abstract

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.

Comparative Risk of Harm Associated With the Use of Targeted Immunomodulators: A Systematic Review

“…We also assessed comparative evidence for nontuberculosis opportunistic infections (48,49), skin infections (32), septic arthritis (50), nonmelanoma skin cancers (45,51,52), melanoma (45), congestive heart failure (53), and interstitial lung disease (54). For all of these outcomes, we identified extremely limited evidence from only observational studies.…”

Differential Adverse Events Between TNF-α Inhibitors and IL-17 Axis Inhibitors for the Treatment of Spondyloarthritis

“…The RATIO registry also has found that infliximab and adalimumab carry a higher risk of a variety of serious non-tuberculous opportunistic infections compared to etanercept [16]. The same registry found a significantly higher risk of herpes zoster infection with monoclonal antibodies to TNF (adalimumab and infliximab) compared to the soluble TNF-α receptor, odds ratio (OR) 3.49 (95 % CI 1.12-10.90, p=0.0316) [17].…”

Infecciones en pacientes reumatológicos asociadas a corticosteroides y antagonistas del factor de necrosis tumoral α

“…Notablemente, este riesgo aparece cuando se ha acumulado una dosis de 700 mg equivalente de prednisona o cuando un usuario crónico utiliza > 10 mg de este compuesto en forma diaria 2 . El concepto de dosis umbral de corticosteroides como factor independiente, ha sido reproducido en numerosos otros trabajos y siempre cercano a los 10-15 mg de prednisona al día (dosis equivalente) 3,4 . El riesgo de infecciones oportunistas en pacientes con corticosteroides por vía inhalatoria es muy bajo y en forma localizada.…”

“…En pacientes que reciben bloqueadores de FNTα se han descrito también infecciones por otros dos agentes intracelulares: L. monocytogenes y especies zoonóticas del género Salmonella 3,58,[60][61][62] . El cuadro clínico dominante en el caso de listeriosis corresponde a infecciones del SNC, las que tienen una alta letalidad 60 .…”