Incidence of tuberculosis in patients receiving anti-TNF therapy for rheumatic diseases: a systematic review

Sartori, Natália Sarzi; Andrade, Nicole Pamplona Bueno de; Chakr, Rafael Mendonça da Silva

doi:10.1007/s10067-019-04866-x

Cited by 24 publications

(19 citation statements)

References 63 publications

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“…The analysis of the risk factors for incident TB revealed that known re-exposure is the most critical cause of this complication. It occurred in a median period of 2 years, and we confirmed the previous observation that new TB infections mostly present as a pulmonary disease ( 18 , 33 , 34 ). In contrast, TB reactivation was observed in approximately one-third of the patients with TB, and the majority of cases were extra-pulmonary with a median of 5.3 months of exposure.…”

Section: Discussionsupporting

confidence: 90%

Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area

Shimabuco

Medeiros-Ribeiro²,

Miossi³

et al. 2020

Clinics

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Section: Discussionsupporting

confidence: 90%

Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area

Shimabuco

Medeiros-Ribeiro²,

Miossi³

et al. 2020

Clinics

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“…In the adjunctive etanercept treated group, the bacterial burden only significantly reduced during the continuation phase of TB treatment, killing more slowly multiplying persister TB bacilli when compared to the standard TB treatment group (12). However, TB reactivation has occurred in patients on anti-TNF therapy and therefore, additional studies are required to carefully evaluate the safety of TNF blockers (112,113).…”

Section: Tumor Necrosis Factor Blockersmentioning

confidence: 99%

Targeting Molecular Inflammatory Pathways in Granuloma as Host-Directed Therapies for Tuberculosis

et al. 2021

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Globally, more than 10 million people developed active tuberculosis (TB), with 1.4 million deaths in 2020. In addition, the emergence of drug-resistant strains in many regions of the world threatens national TB control programs. This requires an understanding of host-pathogen interactions and finding novel treatments including host-directed therapies (HDTs) is of utter importance to tackle the TB epidemic. Mycobacterium tuberculosis (Mtb), the causative agent for TB, mainly infects the lungs causing inflammatory processes leading to immune activation and the development and formation of granulomas. During TB disease progression, the mononuclear inflammatory cell infiltrates which form the central structure of granulomas undergo cellular changes to form epithelioid cells, multinucleated giant cells and foamy macrophages. Granulomas further contain neutrophils, NK cells, dendritic cells and an outer layer composed of T and B lymphocytes and fibroblasts. This complex granulomatous host response can be modulated by Mtb to induce pathological changes damaging host lung tissues ultimately benefiting the persistence and survival of Mtb within host macrophages. The development of cavities is likely to enhance inter-host transmission and caseum could facilitate the dissemination of Mtb to other organs inducing disease progression. This review explores host targets and molecular pathways in the inflammatory granuloma host immune response that may be beneficial as target candidates for HDTs against TB.

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“…Recently variants in the nudix hydrolase 15 (NUDT15) have been shown to cause thiopurine-induced myelosuppression in patients of East Asian ancestry and most recently those of European decent and testing should be considered prior to initiating azathioprine or 6-mp [12,13]. Biologics, in particular, anti-TNF agents exhibit a risk of TB reactivation that varies depending on geography and testing for latent TB prior to initiation of treatment [69]. Baseline labs including assessment of complete blood count and liver enzymes should be obtained and consideration for obtaining measurements of iron, vitamin B12, and vitamin D levels should be considered.…”

Section: Preparation For Initiating Therapy For Ibdmentioning

confidence: 99%

Immunomodulatory Agents for Treatment of Patients with Inflammatory Bowel Disease (Review safety of anti-TNF, Anti-Integrin, Anti IL-12/23, JAK Inhibition, Sphingosine 1-Phosphate Receptor Modulator, Azathioprine / 6-MP and Methotrexate)

Sattler

Hanauer

Malter

2021

Curr Gastroenterol Rep

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Purpose of the ReviewAs treatment options for Inflammatory Bowel Disease (IBD) expand each class of medication will have specific safety concerns and side-effect profiles that need to be considered for optimal treatment of patients. We will review the most recent safety data for the newly approved immunomodulator therapies for the treatment of IBD. Recent Findings There are a growing number of publications outlining safety concerns for medications used to treat IBD. We reviewed safety profile of anti-tumor necrosis factor antibodies (TNF) with specific attention to combination therapy (anti-TNF plus immunomodulator). Recent publications have demonstrated increased risk of serious infection and malignancy (lymphoma and overall cancer rates) in patients receiving anti-TNF combination therapy when compared with patients receiving anti-TNF monotherapy or immunomodulator monotherapy. Recent publications on Janus Kinase Inhibitors indicate an increased risk of infection, specifically Herpes Zoster, and increased risk of major cardiovascular events and venous thromboembolic events resulting in a black box warning for the medication. In contrast, anti-interleukin 12/23 agents and gut selective anti-integrin antibody agents have demonstrated a favorable side-effect profile with low rates of infection and malignancy. The latest class of medications to be approved, sphingosine 1-phosphate (S1P) receptor modulators, have cardiac and infectious precautions. Summary The field of IBD treatment is rapidly evolving with several mechanistic classes of medications now available. While corticosteroids continue to be associated with the greatest, overall, safety risks, each of the newer mechanistic classes have unique safety concerns. In the future, as we gain more experience with these agents, we will need to continue to evaluate the safety profile of our therapies used alone or in combination to make informed treatment decisions with our patients.

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Incidence of tuberculosis in patients receiving anti-TNF therapy for rheumatic diseases: a systematic review

Cited by 24 publications

References 63 publications

Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area

Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area

Targeting Molecular Inflammatory Pathways in Granuloma as Host-Directed Therapies for Tuberculosis

Immunomodulatory Agents for Treatment of Patients with Inflammatory Bowel Disease (Review safety of anti-TNF, Anti-Integrin, Anti IL-12/23, JAK Inhibition, Sphingosine 1-Phosphate Receptor Modulator, Azathioprine / 6-MP and Methotrexate)

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