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Salvana EMT, Salata RA. Infectious complications associated with monoclonal antibodies and related small molecules. Clin Microbiol Rev 2009; 22:274-90, Table of Contents. [PMID: 19366915 PMCID: PMC2668229 DOI: 10.1128/cmr.00040-08] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Biologics are increasingly becoming part of routine disease management. As more agents are developed, the challenge of keeping track of indications and side effects is growing. While biologics represent a milestone in targeted and specific therapy, they are not without drawbacks, and the judicious use of these "magic bullets" is essential if their full potential is to be realized. Infectious complications in particular are not an uncommon side effect of therapy, whether as a direct consequence of the agent or because of the underlying disease process. With this in mind, we have reviewed and summarized the risks of infection and the infectious disease-related complications for all FDA-approved monoclonal antibodies and some related small molecules, and we discuss the probable mechanisms involved in immunosuppression as well as recommendations for prophylaxis and treatment of specific disease entities.
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Affiliation(s)
- Edsel Maurice T Salvana
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio 44106-5083, USA
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52
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Screening of tuberculosis by interferon-γ assay before biologic therapy for rheumatoid arthritis. Tuberculosis (Edinb) 2009; 89:136-41. [PMID: 19211305 DOI: 10.1016/j.tube.2008.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Revised: 12/22/2008] [Accepted: 12/22/2008] [Indexed: 11/22/2022]
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53
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Perlmutter A, Mittal A, Menter A. Tuberculosis and tumour necrosis factor-α inhibitor therapy: a report of three cases in patients with psoriasis. Comprehensive screening and therapeutic guidelines for clinicians. Br J Dermatol 2009; 160:8-15. [DOI: 10.1111/j.1365-2133.2008.08891.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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54
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Abstract
Rheumatoid arthritis patients are at heightened risk for infections because of intrinsic disease severity with associated inflammation, comorbid illnesses, and use of glucocorticoids and various immunosuppressives. Although several studies have reported up to a twofold increase in risk of serious infections in RA patients treated with anti-tumor necrosis factor-alpha agents, results from other studies have been conflicting. Comparing results from different studies is challenging because of differences in patient populations, heterogeneous prevalence of comorbidities, and differing patterns of concomitant medication use. Based on available evidence, an excess risk for infection occurs early after initiation of tumor necrosis factor-alpha inhibitor therapy. Additionally, special circumstances such as surgical procedures may increase infection risk. The appropriate use of biologics in the perioperative setting remains empiric at best.
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55
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Segal B, Rhodus NL, Patel K. Tumor necrosis factor (TNF) inhibitor therapy for rheumatoid arthritis. ACTA ACUST UNITED AC 2008; 106:778-87. [PMID: 18930662 DOI: 10.1016/j.tripleo.2008.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 07/25/2008] [Accepted: 07/28/2008] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterized by inflammation involving large and small joints. Systemic manifestations as well as involvement of paraoral tissues contribute to morbidity. Tumor necrosis factor (TNF) plays a central role in RA by amplifying inflammation in multiple pathways that lead to joint destruction. Tumor necrosis factor inhibitors were first licensed for clinical use in 1998; 3 have been approved for the treatment of RA: Iinfliximab, etanercept, and adalimumab. The purpose of this paper is to review the pathogenesis of RA, the state of the art of therapy, and the most current information on the safety and efficacy of TNF inhibitors for treatment of RA.
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Affiliation(s)
- Barbara Segal
- School of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
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56
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National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents. J Am Acad Dermatol 2008; 59:209-17. [DOI: 10.1016/j.jaad.2008.03.023] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 03/10/2008] [Accepted: 03/18/2008] [Indexed: 12/12/2022]
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57
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Challenges in the management of rheumatoid arthritis in developing countries. Best Pract Res Clin Rheumatol 2008; 22:621-41. [DOI: 10.1016/j.berh.2008.04.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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58
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A novel assay for screening patients for latent tuberculosis infection prior to anti-TNF therapy. ACTA ACUST UNITED AC 2008; 4:456-7. [DOI: 10.1038/ncprheum0865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 06/10/2008] [Indexed: 11/09/2022]
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59
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Winthrop KL, Yamashita S, Beekmann SE, Polgreen PM. Mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor and other newly approved biologic therapies: case finding through the Emerging Infections Network. Clin Infect Dis 2008; 46:1738-40. [PMID: 18419421 DOI: 10.1086/587989] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the results of a nationwide survey of infectious disease consultants to identify mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor compounds and other novel targeted therapies. Nontuberculous mycobacterial infections, histoplasmosis, and invasive Staphylococcus aureus infection were all reported more frequently than was tuberculosis disease in this context.
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60
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Oberstein EM, Kromo O, Tozman EC. Type I reaction of Hansen's disease with exposure to adalimumab: A case report. ACTA ACUST UNITED AC 2008; 59:1040-3. [DOI: 10.1002/art.23815] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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61
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Tuberculosis reactivation during immunosuppressive therapy in rheumatic diseases: diagnostic and therapeutic strategies. Curr Opin Rheumatol 2008; 20:443-9. [DOI: 10.1097/bor.0b013e3283025ec2] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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62
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Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, Paulus HE, Mudano A, Pisu M, Elkins-Melton M, Outman R, Allison JJ, Suarez Almazor M, Bridges SL, Chatham WW, Hochberg M, MacLean C, Mikuls T, Moreland LW, O'Dell J, Turkiewicz AM, Furst DE. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. ACTA ACUST UNITED AC 2008; 59:762-84. [PMID: 18512708 DOI: 10.1002/art.23721] [Citation(s) in RCA: 991] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Rheumatoid arthritis (RA) is often characterized by the burden of swollen joints, pain, and decreased physical function, but less understood are the many manifestations of additional health conditions that are associated with RA and its treatments. First brought to light with observations of increased mortality in RA, studies noted the increased rates of cardiovascular and infection events. The chronic, debilitating, autoimmune nature of RA affects the patient directly or indirectly in almost all organ systems, from cardiovascular problems and infections to depression and gastrointestinal ulcers. On average, the established RA patient has two or more comorbid conditions. It should be the responsibility of the rheumatologist to take these and the risk of additional conditions into account when treating the patient. This chapter reviews important comorbidities in patients with RA, their prevalence, and their relation to RA.
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Affiliation(s)
- Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska 68198-6270, USA.
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64
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Theis VS, Rhodes JM. Review article: minimizing tuberculosis during anti-tumour necrosis factor-alpha treatment of inflammatory bowel disease. Aliment Pharmacol Ther 2008; 27:19-30. [PMID: 17944997 DOI: 10.1111/j.1365-2036.2007.03553.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tumour necrosis factor (TNF)-alpha inhibitors are a major advance in the management of inflammatory bowel disease but increase the risk for tuberculosis (TB). AIM To examine the reasons for the increase in the risk for TB and the strategies to reduce it. METHODS PubMed searches were performed using search terms that included TB and each of the current anti-TNF-alpha biological agents and also TB and Crohn's disease. RESULTS Increased susceptibility to TB, often with extrapulmonary or disseminated disease, occurs following treatment with all anti-TNF-alpha biological agents and amounts to a four- to 20-fold increased risk with infliximab. TB usually occurs shortly after anti-TNF-alpha initiation suggesting reactivation of latent infection. Animal studies show that TNF-alpha inhibition impairs inflammatory cell trafficking and granuloma formation. Currently recommended screening for latent TB typically, risk assessment, tuberculin skin testing and chest radiograph used prior to anti-TNF-alpha treatment can reduce TB rates by up to 90% but newer screening interferon gamma assays may enhance screening efficacy. Patients positive on screening who are treated with isoniazid and subsequently receive anti-TNF-alpha treatment still have approximately 19% risk for TB. CONCLUSIONS Tuberculosis following treatment with TNF-alpha inhibitors usually results from reactivation of latent disease. Screening reduces the risk substantially but does not completely eliminate it.
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Affiliation(s)
- V S Theis
- University Hospital Aintree, Department of Gastroenterology, UK
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65
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Orenstein R, Matteson EL. Opportunistic infections associated with TNF-α treatment. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17460816.2.6.567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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66
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Abstract
Modulation of the immune response with tumor necrosis factor (TNF) blockers is not a new treatment strategy for many inflammatory disorders; however, relatively little is known about their specific mechanism of action. Understanding the mode of action, pharmacology, and pharmacokinetics of the monoclonal TNF antibodies, infliximab and adalimumab, and the soluble TNF receptor, etanercept, may therefore enable us to account for their differing clinical profiles. The aim of this supplement is to explore the roles and mechanisms of TNF and TNF blockade using in vitro pharmacological and in vivo animal modeling experiments, and in vivo studies of the effects of etanercept on the inflammatory cascade in patients with psoriasis.
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Affiliation(s)
- Alice B Gottlieb
- Department of Dermatology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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67
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Winthrop KL. Serious infections with antirheumatic therapy: are biologicals worse? Ann Rheum Dis 2007; 65 Suppl 3:iii54-7. [PMID: 17038474 PMCID: PMC1798385 DOI: 10.1136/ard.2006.058503] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This paper reviews the current evidence for the role of antirheumatic therapy in the development of serious infections in patients with rheumatoid arthritis (RA). Prednisone is clearly associated with increased infectious risk, but no definitive data link methotrexate to infection. Emerging data suggest that biological agents also pose increase infectious risk, particularly when used in combination with corticosteroids or methotrexate. Further research is needed in this important aspect of RA treatment. In the meantime, the author recommends that physicians should remain vigilant for serious infections in their patients with RA and use appropriate vaccines and screening procedures to mitigate their risk.
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Affiliation(s)
- K L Winthrop
- Division of Infectious Diseases, School of Medicine, Oregon Health Sciences University, 3375 SW Terwilliger Boulevard, Portland, OR 97239-4197, USA.
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68
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Hamdi H, Mariette X, Godot V, Weldingh K, Hamid AM, Prejean MV, Baron G, Lemann M, Puechal X, Breban M, Berenbaum F, Delchier JC, Flipo RM, Dautzenberg B, Salmon D, Humbert M, Emilie D. Inhibition of anti-tuberculosis T-lymphocyte function with tumour necrosis factor antagonists. Arthritis Res Ther 2007; 8:R114. [PMID: 16859506 PMCID: PMC1779425 DOI: 10.1186/ar1994] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 06/08/2006] [Accepted: 06/20/2006] [Indexed: 11/30/2022] Open
Abstract
Reactivation of latent Mycobacterium tuberculosis (Mtb) infection is a major complication of anti-tumour necrosis factor (TNF)-α treatment, but its mechanism is not fully understood. We evaluated the effect of the TNF antagonists infliximab (Ifx), adalimumab (Ada) and etanercept (Eta) on anti-mycobacterial immune responses in two conditions: with ex vivo studies from patients treated with TNF antagonists and with the in vitro addition of TNF antagonists to cells stimulated with mycobacterial antigens. In both cases, we analysed the response of CD4+ T lymphocytes to purified protein derivative (PPD) and to culture filtrate protein (CFP)-10, an antigen restricted to Mtb. The tests performed were lymphoproliferation and immediate production of interferon (IFN)-γ. In the 68 patients with inflammatory diseases (rheumatoid arthritis, spondylarthropathy or Crohn's disease), including 31 patients with a previous or latent tuberculosis (TB), 14 weeks of anti-TNF-α treatment had no effect on the proliferation of CD4+ T lymphocytes. In contrast, the number of IFN-γ-releasing CD4+ T lymphocytes decreased for PPD (p < 0.005) and CFP-10 (p < 0.01) in patients with previous TB and for PPD (p < 0.05) in other patients (all vaccinated with Bacille Calmette-Guérin). Treatments with Ifx and with Eta affected IFN-γ release to a similar extent. In vitro addition of TNF antagonists to CD4+ T lymphocytes stimulated with mycobacterial antigens inhibited their proliferation and their expression of membrane-bound TNF (mTNF). These effects occurred late in cultures, suggesting a direct effect of TNF antagonists on activated mTNF+ CD4+ T lymphocytes, and Ifx and Ada were more efficient than Eta. Therefore, TNF antagonists have a dual action on anti-mycobacterial CD4+ T lymphocytes. Administered in vivo, they decrease the frequency of the subpopulation of memory CD4+ T lymphocytes rapidly releasing IFN-γ upon challenge with mycobacterial antigens. Added in vitro, they inhibit the activation of CD4+ T lymphocytes by mycobacterial antigens. Such a dual effect may explain the increased incidence of TB in patients treated with TNF antagonists as well as possible differences between TNF antagonists for the incidence and the clinical presentation of TB reactivation.
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MESH Headings
- Adalimumab
- Antibodies, Bacterial/biosynthesis
- Antibodies, Bacterial/drug effects
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Antigens, Bacterial/immunology
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/immunology
- Bacterial Proteins/immunology
- CD4-Positive T-Lymphocytes/metabolism
- Cells, Cultured
- Crohn Disease/complications
- Crohn Disease/immunology
- Drug Administration Schedule
- Etanercept
- Humans
- Immunoglobulin G/administration & dosage
- Immunoglobulin G/pharmacology
- Infliximab
- Lymphocyte Activation/drug effects
- Mycobacterium tuberculosis/immunology
- Receptors, Tumor Necrosis Factor/administration & dosage
- Spondylarthropathies/complications
- Spondylarthropathies/immunology
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- Tuberculin/immunology
- Tuberculosis/complications
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factors/metabolism
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Affiliation(s)
- Haïfa Hamdi
- INSERM UMR-S764, Service d'Hépato-Gastro-Entérologie and Service de Microbiologie-Immunologie Biologique, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris (AP-HP), Institut Paris-Sud sur les Cytokines, Université Paris-Sud, INSERM U764, 32 rue des Carnets, 92140, Clamart, France
| | - Xavier Mariette
- Service de Rhumatologie, Hôpital Bicêtre, AP-HP, Université Paris-Sud, INSERM U802, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Véronique Godot
- INSERM UMR-S764, Service d'Hépato-Gastro-Entérologie and Service de Microbiologie-Immunologie Biologique, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris (AP-HP), Institut Paris-Sud sur les Cytokines, Université Paris-Sud, INSERM U764, 32 rue des Carnets, 92140, Clamart, France
| | - Karin Weldingh
- Department of Infectious Disease and Immunology, Statens Serum Institut, Copenhagen S, 5 Artillerivej, 2300 Denmark
| | - Abdul Monem Hamid
- Service de Pneumologie, Hôpital A. Béclère, AP-HP, Université Paris-Sud, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - Maria-Victoria Prejean
- INSERM UMR-S764, Service d'Hépato-Gastro-Entérologie and Service de Microbiologie-Immunologie Biologique, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris (AP-HP), Institut Paris-Sud sur les Cytokines, Université Paris-Sud, INSERM U764, 32 rue des Carnets, 92140, Clamart, France
| | - Gabriel Baron
- Département d'Epidémiologie, Biostatistique et Recherche Clinique, Groupe Hospitalier Bichat Claude-Bernard, AP-HP, Université Paris VII, INSERM U738, 46 rue Henri-Huchard, 75018 Paris, France
| | - Marc Lemann
- Service de Gastro-entérologie, Hôpital St. Louis, AP-HP, 1 avenue Claude-vellefaux, 75475 Paris, France
| | - Xavier Puechal
- Service de Rhumatologie, Centre hospitalier du Mans, 194 avenue Rubillard, 72037 Le Mans, France
| | - Maxime Breban
- Service de Rhumatologie, Hôpital A. Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne, France
| | - Francis Berenbaum
- Service de Rhumatologie, Hôpital St. Antoine, AP-HP, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Jean-Charles Delchier
- Service de Gastro-entérologie, Hôpital H. Mondor, AP-HP, 51 rue du Maréchal de Lattre de Tassigny, 94400 Créteil, France
| | - René-Marc Flipo
- Service de Rhumatologie, Hôpital C. Huriez, rue Michel Polonovski, 59037 Lille, France
| | - Bertrand Dautzenberg
- Service de Pneumologie, Hôpital Pitié-Salpétrière, AP-HP, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Dominique Salmon
- Service de Médecine interne et maladies infectieuses, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Marc Humbert
- Service de Pneumologie, Hôpital A. Béclère, AP-HP, Université Paris-Sud, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - Dominique Emilie
- INSERM UMR-S764, Service d'Hépato-Gastro-Entérologie and Service de Microbiologie-Immunologie Biologique, Hôpital Antoine Béclère, Assistance Publique – Hôpitaux de Paris (AP-HP), Institut Paris-Sud sur les Cytokines, Université Paris-Sud, INSERM U764, 32 rue des Carnets, 92140, Clamart, France
- Service de Microbiologie – Immunologie Biologique, Hôpital A. Béclère, AP-HP Université Paris-Sud,, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France
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69
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Winthrop KL. Risk and prevention of tuberculosis and other serious opportunistic infections associated with the inhibition of tumor necrosis factor. ACTA ACUST UNITED AC 2007; 2:602-10. [PMID: 17075599 DOI: 10.1038/ncprheum0336] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 09/13/2006] [Indexed: 02/06/2023]
Abstract
Tumor necrosis factor (TNF) is a proinflammatory cytokine that has a key role in the pathogenesis of a variety of autoimmune diseases-including rheumatoid arthritis-and is an important constituent of the human immune response to infection. At present, three anti-TNF agents are approved (in the US and elsewhere) to treat selected autoimmune diseases: infliximab, etanercept, and adalimumab. These biologic agents have been associated with a variety of serious and 'routine' opportunistic infections; however, differences exist in the mechanisms of action of these agents that might confer variation in their associated risks of infection. From a public-health standpoint, the development of active tuberculosis in some patients who receive anti-TNF therapy is a matter of serious concern. Tuberculosis in such patients frequently presents as extrapulmonary or disseminated disease, and clinicians should be vigilant for tuberculosis in any patient taking anti-TNF therapy who develops fever, weight loss, or cough. To prevent the reactivation of latent tuberculosis infection during anti-TNF therapy, clinicians should screen all patients for tuberculosis, and begin treatment if latent infection is found, before anti-TNF therapy is initiated. Specific tuberculosis screening and treatment strategies vary between geographical regions and are reviewed in this document. The screening strategies employed in Europe and North America have reduced the occurrence of anti-TNF-associated tuberculosis and are clearly to be recommended, but the role of screening in the prevention of other opportunistic (e.g. fungal) infections is far less certain.
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Affiliation(s)
- Kevin L Winthrop
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR 97239-4197, USA.
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70
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Bigbee CL, Gonchoroff DG, Vratsanos G, Nadler SG, Haggerty HG, Flynn JL. Abatacept treatment does not exacerbate chronicMycobacterium tuberculosis infection in mice. ACTA ACUST UNITED AC 2007; 56:2557-65. [PMID: 17665452 DOI: 10.1002/art.22750] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Treatment of rheumatoid arthritis and other autoimmune disorders with anti-tumor necrosis factor (anti-TNF) agents is associated with an increased risk of reactivation of latent Mycobacterium tuberculosis. While the mechanism of action of abatacept is fundamentally different from that of anti-TNF therapies, its effect on the protective response to latent tuberculosis is not known. We undertook this study to determine the effect of abatacept treatment in a murine model of chronic M tuberculosis infection. METHODS Chronic M tuberculosis infection was established in C57BL/6 mice. Four months after infection, mice were treated for up to 16 weeks with abatacept, anti-murine TNF antibody, or vehicle. The primary end point was survival; body weight, bacterial load, histologic features, interferon-gamma (IFNgamma) production by T cells, and cellular infiltration were also assessed. RESULTS Abatacept- and vehicle-treated groups both maintained control of M tuberculosis infection, with 100% survival after 16 weeks of treatment. These 2 groups had no significant differences in body weight, no clinically relevant differences in bacterial load in the lungs, lymph nodes, or spleen, and no differences in the mean percentage of total or activated T cells, macrophages, neutrophils, or B cells, or in IFNgamma production in the lung or lymph nodes. In contrast, 100% mortality was seen in the anti-TNF antibody-treated group by week 9, with significant body weight loss and increased bacterial load in the lungs, lymph nodes, and spleen. Furthermore, the anti-TNF antibody-treated group had increased pathology consistent with the exacerbation of M tuberculosis infection. CONCLUSION Abatacept did not impair the ability of mice to control a chronic M tuberculosis infection. In contrast, mice treated with anti-TNF therapy showed increased pathology and bacterial load, with 100% mortality by week 9. The clinical significance of these findings has not yet been determined.
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Affiliation(s)
- Carolyn L Bigbee
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15261, USA
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71
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Reddy JG, Loftus EV. Safety of infliximab and other biologic agents in the inflammatory bowel diseases. Gastroenterol Clin North Am 2006; 35:837-55. [PMID: 17129816 DOI: 10.1016/j.gtc.2006.09.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In many ways, infliximab has drastically altered expectations for medical therapy in IBD, and it is expected that adalimumab and certolizumab pegol with ultimately have a similar role. Patients initiating such therapy should be made cognizant of the potential risks of serious infection including opportunistic ones, such as TB and histoplasmosis; demyelinating disorders; CHF; and lymphoma. Proper selection of candidates for anti-TNF-alpha therapy is critical in maintaining a proper benefit-to-risk ratio.
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Affiliation(s)
- Jagadeshwar G Reddy
- General Internal Medicine, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA
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72
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HANDA R, MISRA R, CHATURVEDI VP, PISPATI PK, RAO URK, JOSHI VR. Guidelines for tuberculosis prophylaxis during anti-tumour necrosis factor-α treatment: Indian Rheumatology Association. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1479-8077.2006.00181.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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73
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O'Shea FD, Marras TK, Inman RD. Pulmonary sarcoidosis developing during infliximab therapy. ACTA ACUST UNITED AC 2006; 55:978-81. [PMID: 17139647 DOI: 10.1002/art.22351] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Finbar D O'Shea
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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