Safety of resuming tumour necrosis factor inhibitors in patients who developed tuberculosis as a complication of previous TNF inhibitors

Kim, You Jae; Shim, Tae Sun; Koo, Bon San; Hong, Seokchan; Lee, Chang‐Keun; Yoo, Bin

doi:10.1093/rheumatology/keu041

Cited by 29 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There is no consensus on when TNF-α inhibitor therapy can be resumed. However, small case series suggest that it is safe to resume TNF-α inhibitor therapy in patients who complete at least 2 months of antituberculosis treatment and have a good clinical response [380,386,387]. The decision to restart TNF-α inhibitor treatment should be individualized, taking into account the clinical need for immunosuppressive therapy, the extent of tuberculosis disease, and clinical response to antituberculosis treatment.…”

Section: Other Comorbid Conditionsmentioning

confidence: 99%

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Nahid

Dorman

Alipanah

et al. 2016

Clinical Infectious Diseases

1,041

821

View full text Add to dashboard Cite

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.

show abstract

Section: Other Comorbid Conditionsmentioning

confidence: 99%

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Nahid

Dorman

Alipanah

et al. 2016

Clinical Infectious Diseases

1,041

821

View full text Add to dashboard Cite

show abstract

“…There is no guideline available for when or how to restart anti-TNF-α agents for uveitis during or after treatment of active TB. In other fields of medicine where biologics are used, few retrospective studies have found that restarting of the same anti-TNF-α agents and other biological agents, even during ATT appears to be safe 18 19. Furthermore, there is increasing evidence in the literature to support that life-threatening infection may, in fact, prevent autoimmune response by apoptotic depletion of naïve T-cells 20…”

Section: Discussionmentioning

confidence: 99%

Miliary tuberculosis developing during adalimumab treatment for Behçet’s disease with uveitis

Kim¹,

Jones

Steeples

2018

BMJ Case Rep

View full text Add to dashboard Cite

Tumour necrosis factor-alpha (TNF-α) is a key proinflammatory cytokine in non-infective uveitis (NIU). Adalimumab, an anti-TNF-α monoclonal antibody, is approved for the treatment of severe NIU by the European Medicines Agency. There is a recognised risk of serious infections, including tuberculosis (TB), during anti-TNF-α therapy in systemic immune-mediated diseases. We describe miliary pulmonary TB during adalimumab therapy for severe NIU. To our knowledge, this is the first detailed report of this complication in a patient with uveitis. We present the challenges of managing vision-threatening uveitis during life-threatening infection necessitating withdrawal of adalimumab and oral immunosuppression therapy. Uveitis activity was controlled during anti-TB therapy with oral corticosteroid therapy.

show abstract

“…Kim et al. showed that resuming TNFα inhibitors was safe in patients who received anti-TB treatment [12]; however, the optimal time for restarting anti-TNFα treatment has not yet been determined. Our case demonstrated that a flare of circulating TNFα could occur shortly after initiation of anti-TB therapy and discontinuation of TNFα-blocking agents.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical response with increased tumor necrosis factor-α levels to anti-tuberculosis treatment in a patient with disseminated tuberculosis

Watanabe

Kaneko

Kawamoto

et al. 2017

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

It has been reported that tuberculosis (TB) worsens after cessation of tumor necrosis factor-α inhibitors and starting anti-TB treatment. Little is known about the immunological pathogenesis of this paradoxical response (PR). We report the first case of a TB patient in whom PR occurred concurrently with elevation of circulating tumor necrosis factor-α (TNFα) levels. A 75-year-old woman, who had been treated with adalimumab for SAPHO syndrome, developed disseminated TB. Soon after administration of anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol), and after discontinuation of adalimumab, a PR occurred. Serial testing of serum cytokine levels revealed a marked increase in TNFα, and a decline in interferon-γ levels. Despite intensive treatment with antibiotics, prednisolone, noradrenaline, and mechanical ventilation, acute respiratory distress syndrome developed and she died. Thus, overproduction of TNFα after cessation of TNFα inhibitors may partially account for the pathogenesis of a PR. This supports preventative or therapeutic reinitiation of TNFα inhibitors when PR occurs. Serial monitoring of circulating inflammatory cytokine levels could lead to earlier identification of a PR.

show abstract

Safety of resuming tumour necrosis factor inhibitors in patients who developed tuberculosis as a complication of previous TNF inhibitors

Abstract: Our results suggest that resuming TNFi therapy in patients following adequate TB treatment is safe, even before completion of TB treatment.

Cited by 29 publications

References 17 publications

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Miliary tuberculosis developing during adalimumab treatment for Behçet’s disease with uveitis

Paradoxical response with increased tumor necrosis factor-α levels to anti-tuberculosis treatment in a patient with disseminated tuberculosis

Contact Info

Product

Resources

About