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de Souza-Galvão ML, Jiménez-Fuentes MA. Cribado de la tuberculosis latente y terapia biológica. Arch Bronconeumol 2020; 56:139-140. [DOI: 10.1016/j.arbres.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
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Zabana Y, Rodríguez L, Lobatón T, Gordillo J, Montserrat A, Mena R, Beltrán B, Dotti M, Benitez O, Guardiola J, Domènech E, Garcia-Planella E, Calvet X, Piqueras M, Aceituno M, Fernández-Bañares F, Esteve M. Relevant Infections in Inflammatory Bowel Disease, and Their Relationship With Immunosuppressive Therapy and Their Effects on Disease Mortality. J Crohns Colitis 2019; 13:828-837. [PMID: 30668662 DOI: 10.1093/ecco-jcc/jjz013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/12/2019] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS There is controversy as to whether the risk of relevant infection in IBD is related to immunosuppressants or the disease itself. The aims of this study were to evaluate: [1] the life-long prevalence and types of relevant infections in patients with IBD related to immunosuppressive treatment, and [2] the relationship of both infection and patient comorbidity to mortality. METHODS Observational multicentre retrospective study of IBD patients that presented a relevant infection. For each case, four periods of infection exposure were analysed: P1: pre-IBD diagnosis, P2: from IBD diagnosis to immunosuppressant initiation, P3: during immunosuppressant therapy, and P4: after treatment withdrawal. RESULTS The life-long prevalence of relevant infection in the total cohort of patients [6914] was 3%, and 5% in immunosuppressed patients [4202]. 366 relevant infections were found in 212 patients [P1: 9, P2: 17, P3: 334, and P4: 6]. Differences between periods were significant [p < 0.0001]. The most frequent types of infection were respiratory, intestinal and urinary. The most frequent opportunistic infections were tuberculosis [prevalence: 2.6/1000] and herpes zoster [prevalence: 3.9/1000]. Herpes zoster infection was associated with thiopurines alone or in combination with anti-TNF in 75% of the cases, whereas tuberculosis was associated with anti-TNF in 94% of patients. The overall mortality was 4.2%. Infection-related mortality was 2.8% and it was not influenced by comorbidity. CONCLUSIONS Relevant infections in IBD patients are rare and appear to be related to immunosuppression. Relevant infection is a major cause of death in IBD.
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Affiliation(s)
- Yamile Zabana
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
| | | | - Triana Lobatón
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Raquel Mena
- Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Belén Beltrán
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain.,Hospital Universitari i Policlínic La Fe, Valencia, Spain
| | - Marina Dotti
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Olga Benitez
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Xavier Calvet
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain.,Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | - Montserrat Aceituno
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
| | - Fernando Fernández-Bañares
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
| | - Maria Esteve
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
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3
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Taxonera C, Ponferrada Á, Bermejo F, Riestra S, Saro C, Martín-Arranz MD, Cabriada JL, Barreiro-de Acosta M, de Castro ML, López-Serrano P, Barrio J, Suarez C, Iglesias E, Argüelles-Arias F, Ferrer I, Marín-Jiménez I, Hernández-Camba A, Bastida G, Van Domselaar M, Martínez-Montiel P, Olivares D, Alba C, Gisbert JP. Early Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:792-800. [PMID: 28333182 DOI: 10.1093/ecco-jcc/jjx022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage. METHODS In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression. RESULTS We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004]. CONCLUSIONS The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.
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Affiliation(s)
- Carlos Taxonera
- Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Ángel Ponferrada
- Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain
| | - Sabino Riestra
- Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain
| | - Cristina Saro
- Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain
| | | | | | | | - María Luisa de Castro
- Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Pilar López-Serrano
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Cristina Suarez
- Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain
| | - Eva Iglesias
- Department of Gastroenterology, Hospital Reina Sofía, Córdoba, Spain
| | | | - Isabel Ferrer
- Department of Gastroenterology, Hospital de Manises, Manises, Spain
| | - Ignacio Marín-Jiménez
- Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM], Madrid, Spain
| | | | | | | | | | - David Olivares
- Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Cristina Alba
- Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital de la Princesa, CIBEREHD, Madrid, Spain
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Carpio D, Jauregui-Amezaga A, de Francisco R, de Castro L, Barreiro-de Acosta M, Mendoza JL, Mañosa M, Ollero V, Castro B, González-Conde B, Hervías D, Sierra Ausin M, Sancho Del Val L, Botella-Mateu B, Martínez-Cadilla J, Calvo M, Chaparro M, Ginard D, Guerra I, Maroto N, Calvet X, Fernández-Salgado E, Gordillo J, Rojas Feria M. Tuberculosis in Anti-Tumour Necrosis Factor-treated Inflammatory Bowel Disease Patients After the Implementation of Preventive Measures: Compliance With Recommendations and Safety of Retreatment. J Crohns Colitis 2016; 10:1186-93. [PMID: 26802085 DOI: 10.1093/ecco-jcc/jjw022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Despite having adopted preventive measures, tuberculosis (TB) may still occur in patients with inflammatory bowel disease (IBD) treated with anti-tumour necrosis factor (anti-TNF). Data on the causes and characteristics of TB cases in this scenario are lacking. Our aim was to describe the characteristics of TB in anti-TNF-treated IBD patients after the publication of the Spanish TB prevention guidelines in IBD patients and to evaluate the safety of restarting anti-TNF after a TB diagnosis. METHODS In this multicentre, retrospective, descriptive study, TB cases from Spanish hospitals were collected. Continuous variables were reported as mean and standard deviation or median and interquartile range. Categorical variables were described as absolute and relative frequencies and their confidence intervals when necessary. RESULTS We collected 50 TB cases in anti-TNF-treated IBD patients, 60% male, median age 37.3 years (interquartile range [IQR] 30.4-47). Median latency between anti-TNF initiation and first TB symptoms was 155.5 days (IQR 88-301); 34% of TB cases were disseminated and 26% extrapulmonary. In 30 patients (60%), TB cases developed despite compliance with recommended preventive measures; *not performing 2-step TST (tuberculin skin test) was the main failure in compliance with recommendations. In 17 patients (34%) anti-TNF was restarted after a median of 13 months (IQR 7.1-17.3) and there were no cases of TB reactivation. CONCLUSIONS Tuberculosis could still occur in anti-TNF-treated IBD patients despite compliance with recommended preventive measures. A significant number of cases developed when these recommendations were not followed. Restarting anti-TNF treatment in these patients seems to be safe.
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Affiliation(s)
- D Carpio
- Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Biomédica Galicia Sur (IBI), Spain
| | | | | | - L de Castro
- Complexo Hospitalario Universitario, Vigo, Spain
| | | | | | - M Mañosa
- Hospital de Badalona, Barcelona, Spain
| | - V Ollero
- Hospital Universitario Arquitecto Marcide, Ferrol, Spain
| | - B Castro
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - D Hervías
- Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain
| | | | | | | | | | - M Calvo
- Clínica Puerta de Hierro, Madrid, Spain
| | - M Chaparro
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - D Ginard
- Hospital Son Espases, Palma de Mallorca, Spain
| | - I Guerra
- Hospital de Fuenlabrada, Madrid, Spain
| | - N Maroto
- Hospital de Manises, Valencia, Spain
| | - X Calvet
- Institut Universitàri Parc Taulí, Sabadell, Spain
| | - E Fernández-Salgado
- Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Biomédica Galicia Sur (IBI), Spain
| | - J Gordillo
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre el cribado y tratamiento de la tuberculosis latente en pacientes con enfermedad inflamatoria intestinal. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.eii.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Valdivielso Cortázar E, Urman Fernández JM, Bolado Concejo F, Viudez Berral A, Jiménez Mendióroz FJ. [Abdominal tuberculosis diagnosed by endoscopy in a patient under treatment with biological agents]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:385-386. [PMID: 24447890 DOI: 10.1016/j.gastrohep.2013.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
MESH Headings
- Adalimumab
- Adenocarcinoma/complications
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antitubercular Agents/therapeutic use
- Ascites/etiology
- Biological Products/adverse effects
- Biological Products/therapeutic use
- Carcinoma/diagnosis
- Carcinoma/secondary
- Colorectal Neoplasms/complications
- Diagnosis, Differential
- Humans
- Immunocompromised Host
- Male
- Middle Aged
- Peritoneal Neoplasms/diagnosis
- Peritoneal Neoplasms/secondary
- Peritonitis, Tuberculous/diagnosis
- Peritonitis, Tuberculous/drug therapy
- Peritonitis, Tuberculous/etiology
- Spondylarthropathies/complications
- Spondylarthropathies/drug therapy
- Tuberculoma/diagnosis
- Tuberculoma/drug therapy
- Tuberculoma/etiology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/drug therapy
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T-cell profiling and the immunodiagnosis of latent tuberculosis infection in patients with inflammatory bowel disease. Inflamm Bowel Dis 2014; 20:329-38. [PMID: 24378597 DOI: 10.1097/01.mib.0000438429.38423.62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Factors associated with performance of interferon-γ release assays (IGRA) and the tuberculin skin test (TST) in screening for latent tuberculosis infection in patients with inflammatory bowel diseases (IBD) are still poorly understood. The influence of peripheral T-cell subset counts on the results also remain unclear. METHODS Prospective single-center study in 205 patients with IBD. Latent tuberculosis infection screening included a chest radiograph, TST (retest if negative), and 2 IGRAs: QuantiFERON-TB Gold In-Tube (QFT-GIT) and TSPOT-TB (TSPOT). T-cell subpopulations were determined by flow cytometry. RESULTS Twenty-one (10.2%) patients had an abnormal chest radiograph, 55 (26.8%) had a positive TST, 16 (7.8%) had a positive QFT-GIT, and 25 (12.6%) had a positive TSPOT. TST positivity was lower in patients on ≥2 immunosuppressants compared with the controls (5-aminosalicylic acid treatment) (10.4% versus 38.2%, respectively) (P = 0.0057). No other drugs influenced TST or IGRA positivity. In patients on corticosteroid treatment, anti-TNF treatment, or ≥2 immunosuppressants, IGRAs detected 10 cases of latent tuberculosis infection not identified by TST. TSPOT and QFT-GIT increased yield by 56% and 22%, respectively. No significant differences in T-cell subpopulations were found between patients with positive or negative TST or TSPOT results. However, patients with positive QFT-GIT findings had more CD8 T cells (mean, 883 ± 576 versus 484 ± 385 cells per microliter in patients with negative results) (P = 0.022). CONCLUSIONS IGRAs can improve TST-based screening in patients with IBD on immunosuppressive therapy. A low CD8 count can affect QFT-GIT results. We suggest combining TSPOT and TST screening in patients with IBD on immunosuppressants.
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Cardoso IP, de Almeida NP, Gotardo DR, Cardeal M, Santana GO. Tuberculin skin testing in inflammatory bowel disease patients from an endemic area of Brazil. Braz J Infect Dis 2013; 18:60-4. [PMID: 24055308 PMCID: PMC9425264 DOI: 10.1016/j.bjid.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/02/2013] [Accepted: 05/13/2013] [Indexed: 11/20/2022] Open
Abstract
Objective Inflammatory bowel disease (IBD) is a chronic disorder involving the gastrointestinal tract. Immunosuppressive drugs are usually prescribed to treat IBD patients, and this treatment can lead to tuberculosis reactivation. This paper aimed to analyze tuberculin skin test (TST) results in IBD patients at a reference center in Brazil. Methods We evaluated TST results in IBD patients using a cross-sectional study. We also analyzed the medical records of patients treated at a reference IBD outpatient unit where TST is routinely performed. Results We reviewed 119 medical records of 57 (47.9%) Crohn's disease (CD), 57 (47.9%) ulcerative colitis (UC) and 5 (4.2%) indeterminate colitis (IC) patients. The mean (SD) age was 43.5 (13.7) years old. TST was positive in 24 (20.2%) of the patients. TST was positive in 16/57 (28.1%) UC and 6/57 (10.5%) CD patients (prevalence ratio [PR] 2.7). Forty-one patients (34.5%) were taking immunosuppressive drugs (azathioprine or prednisone) at the time of the TST, and six of these patients (14.6%) had positive test results. Two patients using infliximab had negative TST results. Thirty-five of the 41 patients (85.4%) on immunosuppressive treatment were anergic compared with 73.1% (57/78) of the untreated patients (PR 1.2). Conclusions Patients with IBD have TST results similar to the general Brazilian population. Within the IBD population, CD patients have a lower frequency of TST positivity than UC patients.
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Affiliation(s)
- Ingrid Puig Cardoso
- Gastroenterology Unit, Roberto Santos General Hospital, Salvador, BA, Brazil; Bahia School of Medicine and Public Health, Salvador, BA, Brazil
| | | | - Daniela Rosa Gotardo
- Gastroenterology Unit, Roberto Santos General Hospital, Salvador, BA, Brazil; Bahia School of Medicine and Public Health, Salvador, BA, Brazil
| | | | - Genoile Oliveira Santana
- Gastroenterology Unit, Roberto Santos General Hospital, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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Bermejo F, Algaba A, Chaparro M, Taxonera C, Garrido E, García-Arata I, Guerra I, Gisbert JP, Olivares D, de-la-Poza G, López-Sanromán A. How frequently do tuberculosis screening tests convert in inflammatory bowel disease patients on anti-tumour necrosis factor-alpha? A pilot study. Dig Liver Dis 2013; 45:733-7. [PMID: 23587496 DOI: 10.1016/j.dld.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/28/2013] [Accepted: 03/07/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tuberculosis reactivation can lead to severe complications in patients treated with anti-tumour necrosis factor-alpha. AIM To assess the usefulness of repeat tuberculosis screening tests in inflammatory bowel disease patients on stable anti-TNF therapy. METHODS Cross-sectional study, in patients on prolonged anti-TNF treatment (≥ 12 months) and basal negative screening for latent tuberculosis. Quantiferon(®)-TB Gold In-tube test was performed and then, tuberculin skin test was administered. RESULTS 74 patients were included, median duration of anti-TNF treatment was 30 months (IQR 19-54); 47 patients on infliximab and 27 on adalimumab; no patient was on glucocorticoids. Previous BCG vaccination was present in 5 cases. After anti-TNF was started, 4 patients suffered from potential tuberculosis exposure and two cases travelled to endemic areas. The cumulative incidence of tuberculin skin test conversion was 2.7% (95% CI 0.3-9.4%, 2/74), and the incidence rate of tuberculin skin test conversion was 0.83% (95% CI 0.1-2.9%) per patient-year of treatment with anti-TNF drugs. All Quantiferon tests but one (a patient with an indeterminate result and a negative tuberculin skin test) were negative. CONCLUSIONS The incidence rate of conversion of tuberculosis screening tests among patients on anti-TNF treatment seems to be low and these conversions were diagnosed based on a positive tuberculin skin test and were discordant with Quantiferon testing.
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Affiliation(s)
- Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
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Cabriada JL, Vera I, Domènech E, Barreiro-de Acosta M, Esteve M, Gisbert JP, Panés J, Gomollón F. [Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on the use of anti-tumor necrosis factor drugs in inflammatory bowel disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:127-46. [PMID: 23433780 DOI: 10.1016/j.gastrohep.2013.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/21/2013] [Indexed: 12/13/2022]
Affiliation(s)
- José Luis Cabriada
- Servicio de Aparato Digestivo, Hospital Galdakao-Usansolo, Galdakao, Vizcaya, España.
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García-Gasalla M, Fernández-Baca V, Juan-Mas A, Payeras-Cifre A, Cifuentes-Luna C, Taberner-Ferrer R, Riera-Oliver J, Ros-Villamajó I, Navarro-Fernández V, Morey Torrandell C, Gallegos-Alvarez C, Mir-Villadrich I. Use of Quantiferon-TB-Gold in Tube® test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice. Enferm Infecc Microbiol Clin 2013; 31:76-81. [DOI: 10.1016/j.eimc.2012.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 06/10/2012] [Accepted: 06/26/2012] [Indexed: 11/15/2022]
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12
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Arias Guillén M. Avances en el diagnóstico de la infección tuberculosa. Arch Bronconeumol 2011; 47:521-30. [DOI: 10.1016/j.arbres.2011.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 06/03/2011] [Accepted: 06/11/2011] [Indexed: 01/22/2023]
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Carbone J, Perez-Rojas J, Sarmiento E. Infectious pulmonary complications in patients treated with anti-TNF-alpha monoclonal antibodies and soluble TNF receptor. Curr Infect Dis Rep 2010; 11:229-36. [PMID: 19366566 DOI: 10.1007/s11908-009-0034-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tumor necrosis factor (TNF)-alpha inhibitors (infliximab, adalimumab, and etanercept) used in immune-mediated inflammatory diseases such as rheumatoid arthritis, Crohn's disease, or psoriatic arthritis have the potential to increase the risk of infectious complications. Pulmonary infections are one of the most frequent complications associated with the use of TNF inhibitors. This article provides an overview of the distinct types of infectious pulmonary complications seen in patients using these anticytokine drugs.
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Affiliation(s)
- Javier Carbone
- Clinical Immunology Unit, Immunology Department, University Hospital Gregorio Marañon, Dr Esquerdo 46, 28007, Madrid, Spain.
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15
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Salavert M, Bastida G, Pemán J, Nos P. [Opportunistic co-infection in a patient with Crohn's disease during infliximab (anti-TNFalpha) therapy]. Rev Iberoam Micol 2009; 26:213-7. [PMID: 19635442 DOI: 10.1016/j.riam.2009.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 01/19/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The biological therapies for chronic inflammatory diseases of autoimmune origin, particularly drugs inhibiting cytokines, such as the antagonists of the tumoral necrosis factor alpha (TNFalpha), are acceptably well tolerated in patients suffering rheumatologic, dermatologic and gastrointestinal pathologies. Nevertheless, pharmacologic vigilance studies have clarified several aspects of their security in daily clinical use. The adverse effects associated with inhibitors of TNFalpha can be related to the target (or class) and to the agent. The adverse effects related to the target include those potentially attributable to the inherent immunosuppressive state due to the blockade of the main cytokine, phenomenon that could increase the susceptibility to the infections and cancer. AIMS To expound the potential risk of serious infections, opportunistic or not, inherent to the use of biological therapies and, specifically, antagonistic drugs of TNFalpha, from the description of a case of invasive fungal infection. METHODS Revision of clinical records, obtained from the chronic inflammatory disease of autoimmune origin patient database, candidates or recipients of the new biological therapies, and study of the microbiological isolates. RESULTS A case of dual opportunistic infection (nocardiosis and aspergillosis) with a difficult diagnosis and complex management in an immunosupressed patient with Crohn's disease, triggered off after the administration of infliximab (monoclonal antibody anti-TNFalpha) is presented. CONCLUSIONS Invasive fungal infections, with isolated or associated clinical presentation to other opportunistic infections, are emerging in new groups-at-risk as they are the recipients of anti-cytokine biological therapies, regulators of inflammation and immunity. They can be potentially serious in their evolution and a high index of suspicion is needed sometimes for their prompt diagnosis. Possible preventive measures in patients with a high risk of suffering them will have to be investigated.
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Affiliation(s)
- Miguel Salavert
- Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, España.
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Gomollón F, Gisbert JP. [Must immunomodulators be added to biological treatment in inflammatory bowel disease?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 33:43-53. [PMID: 19616870 DOI: 10.1016/j.gastrohep.2009.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 03/06/2009] [Indexed: 02/06/2023]
Abstract
Both biological agents and immunosuppressants are standard treatments in inflammatory bowel disease (IBD) and are frequently used in combination. Although this combination can increase therapeutic efficacy and help to prevent immunogenicity, concerns about the risk of adverse effects - particularly lymphoma - have been raised. IBD are obviously highly complex diseases, with many possible clinical scenarios, and there is no a universal treatment applicable to all patients. In this report we address this issue in a narrative review consisting of three parts. First, we provide a historical overview of the use of immunosuppressants and biological agents in IBD. Secondly, we review the available evidence, with both efficacy and safety considered in separate analyses. Thirdly, we propose different ways of using these drugs in the distinct clinical scenarios, both in Crohn's disease and in ulcerative colitis. Although the evidence is thoroughly reviewed, the main perspective is that of the practicing clinician.
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Affiliation(s)
- Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IACS, CIBEREHD, Zaragoza, España.
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Luis Cabriada J, García Sánchez V, Gomollón F, Hinojosa J, San Román AL, Luis Mendoza J, Mínguez M, Ricart E, Saro C. Recomendaciones de actuación en pacientes con enfermedad de Crohn que empiezan tratamiento con adalimumab: una guía rápida. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:693-7. [DOI: 10.1016/s0210-5705(08)75817-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 05/28/2008] [Indexed: 01/06/2023]
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Zabana Y, Domènech E, San Román AL, Beltrán B, Cabriada JL, Saro C, Araméndiz R, Ginard D, Hinojosa J, Gisbert JP, Mañosa M, Cabré E, Gassull MA. Tuberculous chemoprophylaxis requirements and safety in inflammatory bowel disease patients prior to anti-TNF therapy. Inflamm Bowel Dis 2008; 14:1387-91. [PMID: 18452206 DOI: 10.1002/ibd.20496] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preventive actions are advised since the use of anti-tumor necrosis factor (TNF) agents is known to increase the risk of tuberculosis (TB). No data related to the effectiveness and safety of the preventive chemoprophylaxis (ChP) for TB in inflammatory bowel disease (IBD) patients are available. The goal was to evaluate the requirements, effectiveness, and safety profile of ChP in IBD patient candidates for anti-TNF therapy. METHODS All IBD patients diagnosed with latent TB while evaluated for anti-TNF therapy from the IBD database of 9 Spanish centers were included. Epidemiological and clinical data, risk factors for hepatotoxicity, ChP regimens, and side effects were registered. RESULTS Sixty-three out of 497 IBD evaluated patients (12.5%) had latent TB. Sixty-eight percent were on immunomodulators and 42% on systemic corticosteroids when a TB skin test (TST) was performed. The detection of a positive TST was done in 86% after a single exposure, but 14% needed a booster. All but 1 were treated with isoniazid alone for 6 or 9 months, and only 1 case required ChP discontinuation because of hepatotoxicity. No risk factors for hepatotoxicity were found. No cases of active TB were noticed in the 67 patients further treated with anti-TNF therapy. CONCLUSIONS More than 10% of Spanish IBD patients who are candidates for anti-TNF therapy have latent TB. TST retest is required to identify at least 14% of such patients; therefore, it should be considered if the initial TST is negative. ChP is safe in IBD patients even in those taking concomitant, potentially hepatotoxic drugs.
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Affiliation(s)
- Yamile Zabana
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Catalonia, Badalona, Spain
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Abstract
The timing of the decision for operation in Crohn’s disease is based on an evaluation of the several factors such as the failure of medical treatment, complications due to the Crohn’s disease or to the farmacological therapy, development of dysplasia or cancer and growth retardation. A complete evaluation of these factors should result in operation timed to the patient’s best advantage, achieving maximal relief of symptoms with improvement of quality of life. Given the complexity and heterogeneity of the disease and the different options for treatment, is difficult to systematize when the optimal moment for the surgery is arrived. A very important factor in the management of Crohn’s disease is the multidisciplinary approach and the patient preference should be a significant factor in determining the choice of therapy. The surgery should be considered such another option in the sequential treatment of Crohn’s disease. We have analyzed the factors that are involved in the decision taking of the surgical treatment regarding to the experience and the published literature. When did the medical therapy fail? when is the appropriate moment to operate on the patient? Or which complications of Crohn’s disease need a surgery? These are some of the questions we will try to answer.
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Segarra Cantón O, Infante Pina D, Tormo Carnicé R. [Infliximab therapy for inflammatory bowel disease: seven years on]. An Pediatr (Barc) 2008; 67:344-51. [PMID: 17949644 DOI: 10.1016/s1695-4033(07)70652-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of this study was to describe the clinical experience of our center of the use of infliximab in pediatric patients with inflammatory bowel disease. MATERIAL AND METHODS We retrospectively reviewed all infliximab infusions administered in the Pediatric Gastroenterology Unit from October of 1999 to October of 2006. Fourteen patients (nine with Crohn's disease, three with ulcerative colitis, and two with indeterminate colitis) with a mean age of 9.6 years at diagnosis were treated with infliximab. Seventy-seven infusions were administered. RESULTS Efficacy was analyzed according to inflammatory bowel disease. Crohn's disease: in severe cases (PCDAI > 30), clinical remission (PCDAI < 10) was obtained in 80 % of the patients at week 10, decreasing to 60 % at week 54. Corticosteroid therapy could be reduced in 89 % of the patients and was discontinued in 55.5 %. Ulcerative colitis: clinical remission (modified Truelove-Witts index < 10) was initially obtained in 100 % of the patients but only 33 % were still in clinical remission at the end of the study. In the two corticosteroid-dependent patients, corticosteroid therapy could be reduced and even discontinued in one (50 %). Indeterminate colitis: neither of the two patients achieved clinical remission. The most frequent adverse effects observed were acute infusional reactions (42.8 % of the patients and 10.3 % of infusions), one of which was severe, and infections (28.6 % of patients), one of which (ileal abscess) required surgery. CONCLUSIONS The efficacy of infliximab seems to differ considerably in the distinct types of inflammatory bowel disease and is practically null in indeterminate colitis. Randomized controlled studies in children are required to assess the exact efficacy of infliximab in our patients.
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Affiliation(s)
- O Segarra Cantón
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Materno-Infantil Vall d'Hebron, Barcelona, España.
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Díez M, Sánchez E, García López S, Teresa Arroyo M, Gomollón F. Tratamiento con infliximab en la colitis ulcerosa: experiencia inicial en dos centros de referencia. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:449-53. [DOI: 10.1157/13110489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Meilán Martínez A, Argüelles García B, Anes González G, Luyando LH. Fiebre y cefalea en paciente en tratamiento con infliximab. Rev Clin Esp 2007; 207:371-3. [PMID: 17662206 DOI: 10.1157/13107953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- A Meilán Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
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Gomollón F. Seguridad de los tratamientos en la enfermedad inflamatoria intestinal. GASTROENTEROLOGIA Y HEPATOLOGIA 2006. [DOI: 10.1157/13098294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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