RESEARCH - Infections associated with TNF-alpha antagonists

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Pharmacotherapy. 2005 Sep;25(9):1181-92.

Infections associated with tumor necrosis factor-alpha antagonists.

Rychly DJ, DiPiro JT.

College of Pharmacy, University of Georgia, Athens, Georgia, USA.

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine

involved in a wide range of important physiologic processes. This cytokine

has a pathologic role in some diseases, and TNF-alpha antagonists are

effective in treating inflammatory conditions. Given the putative role of

TNF-alpha in host defense against tuberculosis and other infections, the

risk of infection with TNF-alpha antagonists is a concern. Therefore, we

searched the literature for reports of tuberculosis and other infections

associated with TNF-alpha-antagonist therapy. Although tuberculosis was

rarely reported in randomized clinical comparisons of these antagonists,

case reports and submissions to the MedWatch program of the United States

Food and Drug Administration have been numerous. Most instances were

associated with infliximab, but etanercept and adalimumab may also be

associated with an increased risk of tuberculosis. Histoplasmosis,

listeriosis, aspergillosis, coccidioidomycosis, and candidiasis have been

associated with TNF-alpha antagonists, but the causative relationship is not

clear. Potential recipients of these drugs should be rigorously screened

with skin testing, detailed questioning about recent travel and potential

tuberculosis exposure, assessment for symptoms such as cough and weight

loss, and chest radiography to minimize their risk of acquiring or

reactivating tuberculosis. As with other immunosuppressant drugs, TNF-alpha

antagonists should not be given to patients with active infection.

PMID: 16164393

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16164393 & itool=iconabstr & query_hl=1

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